Treatment of small cell lung cancer

Small cell lung cancer (SCLC) represents approximately 16 percent of all lung cancers and occurs almost exclusively in smokers. Although SCLC is highly responsive to both chemotherapy and radiotherapy (RT), it commonly relapses within months despite treatment. SCLC is highly responsive to multiple chemotherapeutic drugs, and chemotherapy dramatically prolongs survival compared to best supportive care. Randomized trials have shown a survival benefit for combination regimens compared to single agent chemotherapy, and for simultaneous administration of multiple agents as compared to sequential administration of the same agents. While no specific combination has established superiority in the treatment of SCLC, based upon efficacy and toxicity profiles, platinum-based combinations are generally preferred. For patients with limited stage SCLC who are candidates for aggressive therapy, thoracic radiotherapy (RT) administered concurrently with systemic chemotherapy can be used for initial management. For patients with evidence of continuing response at the completion of chemoradiotherapy, prophylactic cranial irradiation is recommended. Second-line chemotherapy may improve survival and quality of life in patients with relapsed or recurrent SCLC, even in patients who do not achieve an objective response. Several single agents and combination regimens have activity in recurrent SCLC. However, the optimal regimen is unclear, and responses generally are short. For patients with relapsed disease and a good performance status, single agent topotecan therapy is recommended. Various targeted therapies, cancer vaccines, and novel cytotoxic agents are currently being evaluated for their role in SCLC.