In a nutshell
In this review, the authors explored different options to treat small cell lung cancer (SCLC) and the challenges associated with them.
Some background
SCLC accounts to 15-20% of all lung cancer. For treatment purposes, SCLC is divided into two stages (phases): limited disease (LD) and extensive disease (ED). In LD, cancer is usually confined to one lung and could be in adjacent lymph nodes (tiny, bean-shaped organs that help fight infections). ED means the cancer has spread widely throughout lungs, adjacent lymph nodes and to other distant organs of the body. Chemotherapy and radiation are the standard methods to treat SCLC. If the cancer comes back after chemotherapy and radiation (first line of treatment), treatment is carried out with a different class of chemotherapy drugs (second line of treatment).
Methods & findings
The authors reviewed several studies of treatments in SCLC.
In a phase 3 clinical trial of 543 SCLC patients, a combination of cisplatin (Platinol) and etoposide (Etopophos) resulted in longer overall survival (14.5 months) compared to treatment with cyclophosphamide (Endoxan), epirubicin (Ellence) and vincristine (Oncovin) (9.7 months) in SCLC patients with limited disease.
In a study of 2,140 SCLC patients with limited disease, chemoradiotherapy (combination of chemotherapy and radiation) resulted in 14% reduction in death when compared to treatment with chemotherapy only. Overall, the best method to treat SCLC patients with limited disease was chemoradiotherapy followed by preventive radiation therapy to the head (cranial irradiation) to prevent cancer from spreading to the brain.
In SCLC patients with extensive disease, a combination of cisplatin or carboplatin (Paraplatin) with etoposide for 4-6 cycles remains the standard treatment. Overall survival was longer with this combination of drugs compared to other chemotherapy agents.
Between amrubicin (Calsed) and topotecan (Hycamtin) as second line of treatment, amrubicin produced marginally better overall survival (7.8 months) compared to topotecan (7.5 months).
The bottom line
In summary, patients with limited SCLC should be treated with chemoradiotherapy followed by cranial irradiation. Extensive SCLC patients should be treated with chemotherapy with cisplatin and etoposide.
The fine print
Finding an effective treatment for SCLC remains a challenge due to poor survival outcome from the existing options.
Published By :
Critical reviews in oncology/hematology
Date :
Apr 02, 2014
