Chemotherapy for Small Cell Lung Carcinoma

Questions to Ask Your Doctor About Lung Cancer
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Small Cell Lung Carcinoma (Limited-Stage)

The following are standard treatment programs for limited-stage small cell lung cancer (SCLC). Combination chemotherapy—with or without prophylactic cranial (head) irradiation, or "PCI," for patients who respond completely—may be especially beneficial for those with impaired lung function or poor performance status. Individuals should be aware that PCI treatment may produce a condition known as leukoencephalopathy or leukodystrophy (degeneration of the brain tissue).

Leukoencephalopathy, which appears, on average, roughly 1 year after irradiation, can cause intellectual changes, memory alterations, and motor (movement) abnormalities.

A number of recent clinical trials have examined the treatment of small cell lung cancer. Of late, some of the most interesting approaches are treatments with biological agents such as monoclonal antibodies (immune system molecules) that are used alone or attached to a toxin; new chemotherapeutic agents; new radiation therapy schedules; new radiation techniques (e.g., three-dimensional treatment planning); and improved timing of chest radiation. Preliminary findings suggest that biological agents, in particular, may be active against SCLC; however, additional time and testing are required.

Small Cell Lung Carcinoma (Extensive-Stage)
A standard treatment method for patients with extensive-stage SCLC is combination chemotherapy, with or without prophylactic cranial irradiation (PCI), for individuals who respond entirely to such therapy. Some commonplace options—which produce similar survival rates—are:

Instead of these options, some physicians only use etoposide (VP-16, VePesid®) for chemotherapy in extensive-stage patients. Other less common combination chemotherapy programs include:

OPTION 9: Combination chemotherapy with cyclophosphamide (Neosar®), doxorubicin (Adriamycin®), etoposide (VP-16, VePesid®), and vincristine sulfate (Oncovin®)

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Radiotherapy (radiation therapy) also may be delivered to metastatic areas that are not immediately destroyed by combination treatment. In particular, radiation may be directed at cancer metastases in the brain, spinal column, and bones.

In contrast to people who have never received chemotherapy, patients with prior chemotherapeutic histories often do not respond as well to additional chemotherapy. These patients, if medically stable, may be prescribed newer agents that are available in clinical trials. Paclitaxel (Taxol®) and topotecan hydrochloride (Hycamtin®) are drugs that are undergoing further evaluation in such studies. Clinical trials normally provide for a change to standard combination therapy if the patient does not show a quick response to treatment.

In October 2007, the FDA approved Hycamtin® capsules for patients with relapsed small cell lung carcinoma following chemotherapy. Side effects of this drug, which is used at least 45 days after the end of first-line chemotherapy, include bone marrow suppression (neutropenia, throbocytopenia, anemia), nausea, and diarrhea.

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