Anlotinib combined with temozolomide for brain metastases in small cell lung cancer with early recurrence after whole-brain radiotherapy: a case report.

Background: Small cell lung cancer (SCLC) is characterised by aggressive biological behaviour and a high propensity for early brain metastasis. Although whole-brain radiotherapy (WBRT) is a standard treatment modality, early intracranial relapse after WBRT remains prevalent and is associated with an exceedingly poor prognosis due to the paucity of effective salvage options. Case presentation: We report the case of a 50-year-old male patient diagnosed with extensive-stage SCLC with brain and pancreatic metastases. The patient received first-line etoposide plus cisplatin(EP) chemotherapy and WBRT with simultaneous integrated boost, but experienced early intracranial and systemic progression approximately 7 months post-WBRT. Second-line immunotherapy-based treatment also failed to control disease progression. Consequently, the patient was administered oral anlotinib (12 mg, days 1-14) in combination with temozolomide (200 mg, days 1-5) as salvage therapy. The combination achieved durable intracranial disease control, significant systemic tumour regression, and deep tumour marker remission, with a progression-free survival of approximately 6 months. Conclusion: The combination of anlotinib and temozolomide has been shown to demonstrate promising efficacy as a salvage treatment for patients with early recurrent brain metastases after WBRT in extensive-stage SCLC. This regimen represents a viable therapeutic option with a manageable safety profile and warrants further prospective evaluation in larger clinical trials.