Recommended treatments for small cell lung cancer

This review summarizes the most effective treatments for small cell lung cancer, based on recent clinical trial data.

There are two types of small-cell lung cancer. Limited stage (LS-SCLC) is cancer that is confined to a single area. Extensive stage (ES-SCLC) has spread past a single area. Recommendations for treatment of cancer usually come from evidence from clinical trials. It is therefore important to constantly update treatment guidelines as research and trials are updated.

This article outlines recommended treatment for patients with SCLC. The authors combined data from the most recent clinical trials using drugs to treat patients with SCLC.

Surgery is rarely an option for patients with SCLC, as they are usually diagnosed late into the disease. In cases where patients are diagnosed early enough for surgery, it is recommended that they have follow-up chemotherapy and radiation therapy. For those with later-stage cancer, radiation to the brain (PCI) to prevent tumors growing there should be considered.

For patients with LS-SCLC, chemotherapy, and radiation followed by PCI is the current standard of care. Common chemotherapy drug combinations include cisplatin (Platinol) and etoposide (Etopophos) or carboplatin (Paraplatin) and etoposide. Radiation should be given early in treatment. For patients in bad health, it can be given later in treatment. The recommended dosage of radiation is 45 Gy twice daily or 60-70 Gy once daily. The recommended dose of PCI is 25 Gy in 10 daily fractions.

For patients with ES-SCLC, chemotherapy is the current recommended standard of care. Combination chemotherapy agents include etoposide and carboplatin. There is not enough data to encourage combining chemotherapy with radiation and PCI, as trials have not shown this to be more effective.

Second-line treatment of ES-SCLC involves further chemotherapy with topotecan (Hycamtin). Some studies have attempted combinations of chemotherapy drugs, however, this needs further research. There were also high levels of side effects.

Some studies have shown benefit with immunotherapies (treatments that stimulate the immune system to attack cancer cells) as second-line treatments. Further studies are needed. It may also only be beneficial in patients with the presence of specific proteins on the tumors. Therefore, patients may need to be screened for these proteins in advance to predict whether treatment will be beneficial. 

The authors summarized the current recommendations on treating patients with small cell lung cancer.