摘 要：小细胞肺癌（SCLC）是一种高度侵袭性的神经内分泌肿瘤，其预后状况差。长久以来，以依托泊苷联合铂类（EP）药物为核心的联合化疗在SCLC的临床治疗中占据主体地位。尽管SCLC对化疗和放疗高度敏感，但患者常在短时间内出现耐药性，使得疾病出现复发及进展的情况。近年来，以程序性死亡受体1（PD-1）及其配体为靶点的免疫检查点抑制剂联合化疗改变了SCLC的治疗格局，成为新的标准一线治疗模式。多项来自全球的高级别临床研究已充分证实，免疫治疗联合化疗可作为一线方案，为广泛期小细胞肺癌（ES-SCLC）患者带来显著的总生存期（OS）获益。免疫治疗耐药性、有效的预测性生物标志物的缺乏以及免疫相关不良反应的管理，仍是当前研究与临床实践中的主要难题。本文旨在对ES-SCLC一线免疫治疗的研究现状与最新进展作系统综述，着重探讨不同免疫联合方案的疗效与安全性，为临床实践和后续研究提供参考。
关键词：广泛期小细胞肺癌；一线治疗；免疫检查点抑制剂；免疫治疗；联合治疗
中图分类号：R734.2      文献标志码：A     DOI：10.3969/j.issn.1007-7146.2026.04.001

Abstract: Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumour with a poor prognosis. For decades, combination chemotherapy based on etoposide plus platinum (EP) constitutes the cornerstone of clinical treatment for SCLC. Although SCLC is highly sensitive to chemotherapy and radiotherapy, patients often develop resistance within a short period, leading to disease recurrence and progression. In recent years, immune checkpoint inhibitors targeting programmed death-1 (PD-1) and its ligand, when combined with chemotherapy, have significantly transformed the treatment landscape for SCLC, establishing a new standard for first-line therapeutic approaches. Numerous high-level clinical studies from global sources have extensively demonstrated that combined immunotherapy and chemotherapy can serve as a first-line treatment, providing significant overall survival (OS) benefits for patients with extensive-stage small cell lung cancer (ES-SCLC). However, challenges such as immunotherapy resistance, the lack of effective predictive biomarkers, and the management of immune-related adverse events persist in current research and clinical practice. This article aims to systematically review the current status and latest advances in first-line immunotherapy for ES-SCLC, focusing on the efficacy and safety of various immunotherapy combination regimens to provide guidance for clinical practice and future research.
Keywords: extensive-stage small cell lung cancer; first-line treatment; immune checkpoint inhibitor; immunotherapy; combination therapy
（Acta Laser Biology Sinica, 2026, 35(4): 289-297）