Lung Cancer Health Center

Small-Cell Lung Cancer

Small-Cell Lung Cancer Treatment continued...

Treatment of limited-stage small-cell lung cancer

• Currently, cisplatin, etoposide, vincristine, doxorubicin, and cyclophosphamide are the most commonly used medications for the treatment of persons with small-cell lung cancer.
• Standard treatment of small-cell lung cancer involves combination chemotherapy with a cisplatin-containing regimen. Treatment cycles are repeated every three weeks. People receive treatment for four to six cycles.
• The combination of cisplatin and etoposide (PE) is the most widely used regimen in both limited- and extensive-stage small-cell lung cancer. 
• Some doctors start radiotherapy to the chest as early as possible, while others may give it with the fourth cycle of chemotherapy.
• Radiation and chemotherapy: Sequential-radiation treatment may be given, followed by chemotherapy.
• However, in comparative studies, the earlier the radiation is started concurrently with chemotherapy (as early as the first cycle of chemotherapy), the better the outcome.
• If the patient has limited disease, and has had a complete remission, of the cancer, radiation therapy may be given to the patient’s brain to reduce the risk of small-cell lung cancer spreading to the brain. This is called prophylactic cranial irradiation (PCI). It is usually given after the patient has completed the full chemotherapy, and radiotherapy (to the thorax). The radiation doses are low, and the treatment duration is short, so the side effects of this therapy are minimal.

Treatment of extensive-stage small-cell lung cancer (small-cell lung cancer that remains incurable with current treatment options) 

• Persons with extensive-stage small-cell lung cancer are treated with combination chemotherapy. Currently, the combination of cisplatin or carboplatin and etoposide (PE) is the most widely used regimen.
• Radiation therapy may be used for relief of the following symptoms:
  • Bone pain
  • Compression of the food pipe (esophagus), windpipe, spinal cord, or superior vena cava caused by tumors
  • Obstructive pneumonia caused by the tumor

Treatment of relapse of small-cell lung cancer

• Persons who have a relapse of small-cell lung cancer have an extremely poor prognosis. 
• If the disease does not respond to treatment or progresses after initial treatment (called "refractory disease") or if the disease relapses within six months of completion of therapy, the person has little chance of responding to additional chemotherapy. The most common drug used in this setting is topotecan.
• Persons whose cancer does not progress for more than six months may be given additional chemotherapy, including re-treatment with their original chemotherapy regimen.
• Persons with relapsed or refractory small-cell lung cancer may enroll in a clinical trial. For information about ongoing clinical trials, visit the National Cancer Institute's Clinical Trials.

Other drugs may be given to prevent and treat adverse effects of radiation, chemotherapy, or the cancer itself, such as nausea or vomiting. Pain medications are also important to relieve pain due to cancer or its treatment.

Surgery