Management of small cell lung cancer

Abstract

Small cell lung cancer (SCLC) is an aggressive type of lung cancer characterized by rapid growth and early metastasis. It is chemosensitive and radiosensitive, yet decades of research investigating multimodality treatments have failed to control or cure this disease in most patients. First-line treatment of limited-stage disease consists of chemotherapy (often etoposide/cisplatin or etoposide/carboplatin) combined with thoracic radiation therapy (TRT), followed by prophylactic cranial irradiation to decrease brain metastases as a site of disease progression for those who experience complete remission or a very good partial response to multimodality treatment. In a Japanese trial, the combination of irinotecan and cisplatin had initially shown promise in treating patients with extensive-stage SCLC, but a confirmatory trial in the United States did not find a difference in overall survival with irinotecan/cisplatin versus etoposide/cisplatin. Adding a third drug to the etoposide/cisplatin combination, as well as other triplet therapies, has mostly been ineffective in improving outcomes. Variables in chemotherapy administration, including maintenance therapy, alternating non-cross-resistance regimens, and dose intensification, have not been shown to increase survival at large. In terms of radiation therapy, early administration of TRT concurrent with chemotherapy, and hyperfractionation, have been beneficial in treatment of limited-stage disease. In patients who relapse, second-line therapy options consist of reinduction of previous chemotherapy or administration of a single agent. Targeted biological therapies for SCLC are now being investigated, and although a great deal of research remains to be done, these agents and their derivatives may provide the most hope for future treatment of SCLC.

Active immunotherapy with 1E10 anti-idiotype vaccine in patients with small cell lung cancer: Report of a phase I trial

“…Recent trials confirm no impact in patient's survival of the addition of new chemo-therapeutics agents to standard cisplatin and etoposide first-line treatment. 5,27 Thus, new approaches to improve survival of SCLC are needed.…”

Regulation of the NRSF/REST gene by methylation and CREB affects the cellular phenotype of small-cell lung cancer

“…SCLC is an aggressive and rapidly growing tumour with early metastasis and a mean survival time from diagnosis of only a few months (Ciombor and Rocha Lima, 2006). Whereas NSCLC is of epithelial origin, SCLC shares morphological properties with neuroendocrine cells (Chong et al, 2006).…”

Methylation Induced Gene Silencing of HtrA3 in Smoking-Related Lung Cancer

“…Standard first line treatment for small-cell lung cancer (SCLC) includes platinum-based chemotherapy, generally with the DNA and protein cross-linking agent cis-platinum-(II)-diamine dichloride (cisplatin) or carboplatin plus etoposide, a topoisomerase II inhibitor, with or without radiation (3)(4)(5)(6). Treatment of non-small cell lung carcinoma may include surgical resection, radiotherapy, and/or platinum-based chemotherapy (7)(8)(9)(10).…”