Tislelizumab plus chemotherapy followed by anlotinib maintenance therapy in a patient with extensive-stage small cell lung cancer and intracranial recurrence after palliative whole-brain radiotherapy: a case report and literature review.

Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancer cases. It is characterized by an exceptionally high proliferative rate, a strong propensity for early metastasis, and a poor prognosis. The median overall survival (OS) following brain metastases development in extensive-stage SCLC (ES-SCLC) was 10.5 months. Herein, a 74-year-old Chinese male was initially diagnosed with ES-SCLC with synchronous hepatic metastases. Following four cycles of first-line chemotherapy comprising etoposide and carboplatin, the patient underwent thoracic radiotherapy (TRT); however, prophylactic cranial irradiation was not performed. Brain metastases were detected 19 months after TRT, prompting initiation of palliative whole-brain RT (WBRT). Intracranial disease recurrence was observed five months after completion of WBRT. Managing intracranial recurrence following palliative WBRT in patients with ES-SCLC is clinically challenging. In this case of intracranial recurrence following palliative WBRT, the patient received second-line therapy comprising tislelizumab in combination with irinotecan and cisplatin chemotherapy, followed by anlotinib as maintenance therapy, achieving a complete response, sustained status of no evidence of disease for 24 months, and an OS of 67 months. Based on this case, tislelizumab combined with chemotherapy followed by anlotinib maintenance therapy represents a potentially viable treatment strategy for patients with recurrent intracranial lesions following palliative WBRT who have not received prior immune checkpoint inhibitor therapy. However, given the limited evidence derived solely from a single case, the clinical utility of this regimen requires validation in prospective and controlled trials.