{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:49:25Z","timestamp":1782744565667,"version":"3.54.5"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,28]],"date-time":"2024-07-28T00:00:00Z","timestamp":1722124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: Small-cell lung cancer (SCLC) is an aggressive form of cancer with a poor prognosis. The two-year survival rate is 8% of all cases. Case presentation: We present the case of a male patient who was 50 years old at the time of diagnosis in May 2022. He was diagnosed with extensive-stage small-cell lung cancer, treated with immunotherapy in combination with chemotherapy (Durvalumab in combination with Etoposide plus Carboplatin) as a first-line treatment, followed by maintenance immunotherapy. In December 2023, a PET-CT scan revealed progressive disease with multiple metastases. Chemotherapy was reinitiated with Etoposide plus Cisplatin in January 2024. After two cycles of chemotherapy, the patient developed post-chemotherapy anemia, for which treatment with Epoetinum alpha was initiated. Chemotherapy was continued for another five cycles, until May 2024, with the maintenance of hemoglobin at a level within 9.9 mg\/dL\u201311 mg\/dL. Upon assessment at the end of May 2024, the patient presented an ECOG = 2 performance status, with a moderate general state, moderate-intensity fatigue, no pain, no anxiety or depression and no dyspnea. Discussions, Literature Review and Conclusions: Reinitiating chemotherapy after the failure of maintenance immunotherapy may be an option in patients with SCLC. Epoetinum allows oncological treatment by preventing chemotherapy-induced anemia.<\/jats:p>","DOI":"10.3390\/medicina60081225","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T07:54:03Z","timestamp":1722239643000},"page":"1225","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reinitiating Chemotherapy beyond Progression after Maintenance Immunotherapy in Extensive-Stage Small-Cell Lung Cancer"],"prefix":"10.3390","volume":"60","author":[{"given":"Roxana-Andreea","family":"Rahnea-Nita","sequence":"first","affiliation":[{"name":"8th Clinical Department\u2014Radiology, Oncology and Hematology, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Phamacy, 020021 Bucharest, Romania"},{"name":"Department of Oncology-Palliative Care, \u201cSf. Luca\u201d Chronic Diseases Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu-Valeriu","family":"Toma","sequence":"additional","affiliation":[{"name":"8th Clinical Department\u2014Radiology, Oncology and Hematology, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Phamacy, 020021 Bucharest, Romania"},{"name":"Department of Radiotherapy, \u201cProf. Dr. Alexandru Trestioreanu\u201d Oncological Institute, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin Titus","family":"Grigorean","sequence":"additional","affiliation":[{"name":"10th Clinical Department\u2014General Surgery, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0535-7100","authenticated-orcid":false,"given":"Ionu\u0163 Simion","family":"Coman","sequence":"additional","affiliation":[{"name":"10th Clinical Department\u2014General Surgery, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violeta Elena","family":"Coman","sequence":"additional","affiliation":[{"name":"10th Clinical Department\u2014General Surgery, Faculty of Medicine, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of General Surgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iancu Emil","family":"Ple\u015fea","sequence":"additional","affiliation":[{"name":"Department of Histopathology, \u201cBagdasar-Arseni Clinical Emergency Hospital\u201d, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anwar","family":"Erchid","sequence":"additional","affiliation":[{"name":"Department of General Surgery, \u201cBagdasar-Arseni\u201d Clinical Emergency Hospital, 041915 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5340-8929","authenticated-orcid":false,"given":"Gabriel-Petre","family":"Gorecki","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Faculty of Medicine, \u201cTitu Maiorescu\u201d University, 031593 Bucharest, Romania"},{"name":"Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Rahnea-Nita","sequence":"additional","affiliation":[{"name":"Department of Oncology-Palliative Care, \u201cSf. Luca\u201d Chronic Diseases Hospital, 041915 Bucharest, Romania"},{"name":"Specific Disciplines Department, Faculty of Nursing and Midwifery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Dawe, D.E., Rittberg, R., Syed, I., Shanahan, M.K., Moldaver, D., Bucher, O., Galloway, K., Reynolds, K., Paul, J.T., and Harlos, C. (2023). Real-world predictors of survival in patients with extensive-stage small-cell lung cancer in Manitoba, Canada: A retrospective cohort study. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1191855"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41572-020-00235-0","article-title":"Small-cell lung cancer","volume":"7","author":"Rudin","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/978-3-319-40389-2_14","article-title":"Small Cell Lung Cancer","volume":"170","author":"Bernhardt","year":"2016","journal-title":"Cancer Treat. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jtho.2022.10.002","article-title":"SCLC: Epidemiology, Risk Factors, Genetic Susceptibility, Molecular Pathology, Screening, and Early Detection","volume":"18","author":"Wang","year":"2023","journal-title":"J. Thorac. Oncol."},{"key":"ref_5","unstructured":"Basumallik, N., and Agarwal, M. (2024). Small Cell Lung Cancer. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Belluomini, L., Calvetti, L., Inno, A., Pasello, G., Roca, E., Vattemi, E., Veccia, A., Menis, J., and Pilotto, S. (2022). SCLC Treatment in the Immuno-Oncology Era: Current Evidence and Unmet Needs. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.840783"},{"key":"ref_7","first-page":"355","article-title":"Neuroendocrine renal carcinoma\u2014Therapeutic and diagnostic issue","volume":"12","author":"Badiu","year":"2016","journal-title":"Acta Endocrinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"657","DOI":"10.2147\/OTT.S272552","article-title":"Extensive-Stage Small-Cell Lung Cancer: Current Landscape and Future Prospects","volume":"16","author":"Saida","year":"2023","journal-title":"OncoTargets Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.pharmthera.2017.06.002","article-title":"Treatment advances in small cell lung cancer (SCLC)","volume":"180","author":"Waqar","year":"2017","journal-title":"Pharmacol. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100408","DOI":"10.1016\/j.esmoop.2022.100408","article-title":"Durvalumab, with or without tremelimumab, plus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer: 3-year overall survival update from CASPIAN","volume":"7","author":"Chen","year":"2022","journal-title":"ESMO Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"517","DOI":"10.18632\/oncotarget.28444","article-title":"Value of chemotherapy post immunotherapy in stage IV non-small cell lung cancer (NSCLC)","volume":"14","author":"Assi","year":"2023","journal-title":"Oncotarget"},{"key":"ref_12","first-page":"1082","article-title":"Antianemic effect of once weekly regimen of epoetin alfa 40,000 units in anemic cancer patients receiving chemotherapy","volume":"90","author":"Voravud","year":"2007","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1177\/082585979100700202","article-title":"The Edmonton Symptom Assessment System (ESAS): A Simple Method for the Assessment of Palliative Care Patients","volume":"7","author":"Bruera","year":"1991","journal-title":"J. Palliat. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1002\/(SICI)1097-0142(20000501)88:9<2164::AID-CNCR24>3.0.CO;2-5","article-title":"Validation of the Edmonton Symptom Assessment Scale","volume":"88","author":"Chang","year":"2000","journal-title":"Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.jpainsymman.2016.10.370","article-title":"The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments","volume":"53","author":"Hui","year":"2017","journal-title":"J. Pain. Symptom Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0022-3999(01)00296-3","article-title":"The validity of the Hospital Anxiety and Depression Scale. An updated literature review","volume":"52","author":"Bjelland","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The Hospital Anxiety and Depression Scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e372","DOI":"10.3747\/co.26.4481","article-title":"Initial management of small-cell lung cancer (limited- and extensive-stage) and the role of thoracic radiotherapy and first-line chemotherapy: A systematic review","volume":"26","author":"Sun","year":"2019","journal-title":"Curr. Oncol."},{"key":"ref_20","first-page":"100266","article-title":"Prognostic value of clinical staging according to TNM in patients with SCLC: A real-world surveillance epidemiology and end-results database analysis","volume":"3","author":"Arriola","year":"2021","journal-title":"JTO Clin. Res. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1016\/j.mayocp.2019.01.034","article-title":"Current diagnosis and management of small-cell lung cancer","volume":"94","author":"Wang","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6039","DOI":"10.2147\/CMAR.S181789","article-title":"Prognostic significance of the 8th edition of the TNM classification for patients with extensive disease small cell lung cancer","volume":"10","author":"Shirasawa","year":"2018","journal-title":"Cancer Manag. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s41030-023-00229-9","article-title":"Symptoms and Experiences with Small Cell Lung Cancer: A Mixed Methods Study of Patients and Caregivers","volume":"9","author":"Bebb","year":"2023","journal-title":"Pulm. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5-15-22","DOI":"10.1158\/1538-7445.SABCS14-P5-15-22","article-title":"Abstract P5-15-22: Evaluation of quality of life in patients with advanced and metastatic breast cancer proposed for palliative chemotherapy and best supportive care versus best supportive care","volume":"75","author":"Ciuhu","year":"2015","journal-title":"Cancer Res."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rahnea-Nita, R.A., Stoian, A.R., Anghel, R.M., Rebegea, L.F., Ciuhu, A.N., Bacinschi, X.E., Zgura, A.F., Trifanescu, O.G., Toma, R.V., and Constantin, G.B. (2023). The Efficacy of Immunotherapy in Long-Term Survival in Non-Small Cell Lung Cancer (NSCLC) Associated with the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Life, 13.","DOI":"10.3390\/life13061279"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.2217\/imt-2021-0135","article-title":"Chemotherapy or chemo-immunotherapy as first-line treatment for extensive-stage small-cell lung cancer: A meta-analysis","volume":"13","author":"Chen","year":"2021","journal-title":"Immunotherapy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1159\/000508516","article-title":"Use of Immunotherapy in Extensive-Stage Small Cell Lung Cancer","volume":"98","author":"Konala","year":"2020","journal-title":"Oncology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s11864-022-00949-1","article-title":"Immunotherapy in Small Cell Lung Cancer Treatment: A Promising Headway for Future Perspective","volume":"23","author":"Walia","year":"2022","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Rahnea-Nita, R.A., Rebegea, L.F., Toma, R.V., Mocanu, H., Soare, I., Mihailov, R., Nechifor, A., Guliciuc, M., Constantin, G.B., and Rahnea-Nita, G. (2024). Immunotherapy Combined with Radiation in Malignant Melanoma without BRAF Mutations Brain Metastases\u2014Favorable Response after Immunotherapy Continued beyond Progression. J. Pers. Med., 14.","DOI":"10.3390\/jpm14010086"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kang, D.H., Choi, C.M., Park, C.K., Oh, I.J., Kim, Y.C., Yoon, S.H., Kim, Y., and Lee, J.E. (Tuberc. Respir. Dis., 2024). Immune checkpoint inhibitor score (IChIS) predicts survival benefit of immunotherapy in patients with non-small cell lung cancer, Tuberc. Respir. Dis., ahead of print.","DOI":"10.4046\/trd.2023.0190"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Meriggi, F. (2024). Second-Line Treatment Options for Small-Cell Lung Cancer: A Light at the End of the Tunnel. Cancers, 16.","DOI":"10.3390\/cancers16020255"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"91795","DOI":"10.18632\/oncotarget.20030","article-title":"Excellent response to chemotherapy post immunotherapy","volume":"8","author":"Dwary","year":"2017","journal-title":"Oncotarget"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3554","DOI":"10.21037\/jtd-23-858","article-title":"Efficacy of second-line chemotherapy after immunotherapy in advanced non-small cell lung cancer","volume":"15","author":"Hirata","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/sonc.2002.33539","article-title":"The use of epoetin alfa in chemotherapy patients: A consistent profile of efficacy and safety","volume":"29","author":"Itri","year":"2002","journal-title":"Semin. Oncol."},{"key":"ref_35","unstructured":"Rahnea-Nita, G. (2013). Aspecte de Teorie si Practica in Ingrijirea Paliativa, Editura Universitara."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Barca-Hernando, M., Mu\u00f1oz-Martin, A.J., Rios-Herranz, E., Garcia-Escobar, I., Beato, C., Font, C., Oncala-Sibajas, E., Revuelta-Rodriguez, A., Areses, M.C., and Rivas-Jimenez, V. (2021). Case-Control Analysis of the Impact of Anemia on Quality of Life in Patients with Cancer: A Qca Study Analysis. Cancers, 13.","DOI":"10.3390\/cancers13112517"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1200\/JCO.2001.19.11.2865","article-title":"Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: Results of a randomized, double-blind, placebo-controlled trial","volume":"19","author":"Littlewood","year":"2001","journal-title":"J. Clin. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3816\/CBC.2005.n.015","article-title":"Weekly epoetin alfa during adjuvant chemotherapy for breast cancer: Effect on hemoglobin levels and quality of life","volume":"6","author":"Hudis","year":"2005","journal-title":"Clin. Breast Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"9377","DOI":"10.1200\/JCO.2005.01.8507","article-title":"Efficacy and safety analysis of epoetin alfa in patients with small-cell lung cancer: A randomized, double-blind, placebo-controlled trial","volume":"23","author":"Grote","year":"2005","journal-title":"J. Clin. Oncol."},{"key":"ref_40","unstructured":"Parker, S.D., King, N., and Jacobs, T.F. (2024). Pegfilgrastim. StatPearls [Internet], StatPearls Publishing."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1225\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:25:32Z","timestamp":1760109932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1225"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,28]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["medicina60081225"],"URL":"https:\/\/doi.org\/10.3390\/medicina60081225","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,28]]}}}