INTRODUCTION Extensive-stage small cell lung cancer (ES-SCLC) is yet to be considered an oncologic clinical condition characterized by a dismal prognosis. However, about 5 years ago, the introduction of immunotherapy in the first-line regimens, combined with platin-based chemotherapy, has produced an improvement of survival outcomes for this patient population. AREAS COVERED In the last year, two innovative approaches have further improved efficacy outcomes for ES-SCLC patients. The addition of lurbinectedin to the immunotherapeutic drug atezolizumab in the maintenance phase of first-line treatment, and the introduction of the bispecific T-cell engager antibody tarlatamab as second-line treatment, have established two new standards of care for the treatment of ES-SCLC. Moreover, ongoing phase III trials are testing the possibility to introduce tarlatamab in the first-line setting, as induction or as maintenance. Simultaneosusly, phase II trials have reported very promising antitumor activity for ifinitamab deruxtecan and sacituzumab govitecan, two antibody drug conjugates in the second-line setting, and phase III trials are ongoing. EXPERT OPINION As never in the past, the prognosis of ES-SCLC patients seems characterized by a new light, with innovative drugs that used combined or sequentially, have the potential of a substantial change of the natural history of this aggressive disease.
INTRODUCTION Joint hypermobility-related pain is an increasingly recognized musculoskeletal pain characterized by mixed pain mechanisms, frequent chronicity, and an incompletely defined natural history. Joint hypermobility-related pain may occur in monogenic Ehlers-Danlos syndromes, but it is more frequently encountered in people with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome, conditions that remain molecularly unresolved. AREAS COVERED This article places joint hypermobility-related pain in its historical and conceptual context, summarizes the mechanisms thought to contribute to its development, and critically reviews pharmacotherapeutic evidence identified in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and WHO ICTRP without date restrictions. EXPERT OPINION Current evidence is low-level and does not support the efficacy of any disease-specific, repurposed, or novel drug for joint hypermobility-related pain. Medication alone may be appropriate for occasional or recurrent pain and predominantly nociceptive flares. Chronicity, musculoskeletal disability, and overlapping nociceptive, neuropathic, and nociplastic mechanisms limit the effectiveness of drug-only strategies and envisage multimodal management. Pharmacological approach should stand on one drug at a time, usually at a low dose, and benefit and adverse burden should be reassessed after a predefined trial. Patients are best managed by keeping the diagnostic and therapeutic pathways separate.
