Limertinib Plus Carboplatin and Etoposide for EGFR-mutant NSCLC With SCLC Transformation After EGFR-TKI Progression

Prior treatment

• Prior treatment with a standard SCLC chemotherapy regimen (e.g., carboplatin/etoposide or cisplatin/etoposide) after SCLC transformation.
• Symptomatic or unstable brain metastases. Patients with a history of unstable brain metastases must have undergone definitive surgery or radiotherapy, remain clinically stable, and be off corticosteroids for cerebral edema for at least 14 days before enrollment.

Other illness

• Histology at initial diagnosis of small-cell lung cancer (SCLC), large-cell carcinoma, or mixed tumor with predominant SCLC, large-cell, or neuroendocrine components.
• Active hepatitis B (HBV DNA \> 1,000 IU/mL) or hepatitis C infection (anti-HCV positive and/or HCV RNA \> 15 IU/L), or known HIV infection.
• Known hypersensitivity to lietinib, carboplatin, or etoposide.
• Psychiatric or cognitive disorders that would preclude informed consent or compliance with study requirements.
• Any other medical or psychosocial condition judged by the investigator to compromise patient safety or study integrity (e.g., poor compliance or comorbidities affecting efficacy assessment).

Lab values

• Pregnancy (confirmed by serum ß-hCG) or breastfeeding. Note: Women who have been postmenopausal for ≥ 12 months, or who have undergone hysterectomy, bilateral oophorectomy, or bilateral tubal ligation, are exempt from contraception requirements. Male participants must use effective contraception from the first dose of study drug until 180 days after the last dose.

Age

• Any concurrent malignancy other than basal cell carcinoma of the skin or carcinoma in situ of the cervix. (Patients with a prior malignancy must be disease-free for ≥ 5 years to be eligible.)

Other

• Patients meeting any of the following criteria will be excluded from the study:
• Women planning pregnancy during the screening period or who, along with their partners, are not using effective contraception.

• Patients must meet all of the following to be eligible for enrollment:
• Signed written informed consent prior to any study-related procedures.
• Age ≥ 18 and ≤ 80 years.
• Histologically or cytologically confirmed non-small cell lung cancer (NSCLC) with a sensitizing EGFR mutation (exon 19 deletion or L858R, with or without concurrent mutations).
• Prior treatment with EGFR-TKI, with documented disease progression and histologically confirmed small-cell lung cancer (SCLC) transformation.
• At least one measurable target lesion per RECIST v1.1.
• ECOG performance status 0-1 (see Appendix for ECOG scale).
• Estimated life expectancy \> 3 months.
• Adequate bone marrow function, defined as:
• ANC ≥ 1,500/mm³
• Hemoglobin ≥ 9 g/dL
• Platelets ≥ 90,000/mm³
• Adequate hepatic function, defined as:
• Total bilirubin ≤ 1.5 × ULN
• AST and ALT ≤ 2.5 × ULN (or ≤ 5 × ULN in patients with known hepatic metastases)
• Adequate renal function, defined as:
• Serum creatinine within normal limits OR creatinine clearance ≥ 50 mL/min (Cockcroft-Gault)
• For patients with BMI \< 18.5 or \> 30, eGFR ≥ 50 mL/min (MDRD) is acceptable
• Adequate cardiac function, defined as LVEF ≥ 50% by MUGA scan or echocardiography.
• Women of childbearing potential and men with partners of childbearing potential must agree to use effective contraception.