[Comment] Rethinking immunotherapy in patients with SCLC with poor performance status

The addition of immune checkpoint inhibitors (ICI) to first-line platinum-doublet chemotherapy has substantially improved long-term outcomes in a subset of patients with extensive-stage small-cell lung cancer (SCLC), with 3-year survival rates reaching 16–18%, compared with approximately 6% with chemotherapy alone, as shown in phase 3 studies such as the CASPIAN and IMpower133 trials.1,2 However, these trials were highly selective, excluding patients with poor Eastern Cooperative Oncology Group performance status (ie, ≥2) and impaired organ function, raising concerns about the generalisability of their outcomes to real-world settings, in which 33–88% of patients would not have met eligibility criteria.