Management of small cell cancer of the lung

Small cell lung cancer (SCLC) accounts for 20% to 25% of bronchogenic carcinoma cases. Combination chemotherapy offers the best chance for improved survival. Cisplatin plus etoposide appears to be the most reasonable choice for first line therapy. Increasing dose intensity, although sometimes associated with higher response rates, does not appear to significantly improve survival. Concurrent thoracic radiotherapy administered early in the course of chemotherapy confers a survival advantage over chemotherapy alone in limited-stage SCLC. Prophylactic cranial irradiation reduces central nervous system recurrences with minimal long-term sequelae and appears to improve survival. Several new cytotoxic agents are active in SCLC. These include gemcitabine, paclitaxel, docetaxel, topotecan, irinotecan, and JM216. Novel approaches being investigated include antibodies to factors expressed by SCLC cells and agents targeting angiogenesis, cell cycle regulation, and cell-signaling pathways. (C) 2000 Lippincott Williams and Wilkins, Inc.