Until recently, many advancements in treating lung cancer have centered on non-small-cell lung cancer (NSCLC). But new therapies for small-cell lung cancer (SCLC) have started to emerge, and the early results are promising.
SCLC is an aggressive form of lung cancer, and new treatments are key for improving the outlook for people diagnosed with it.
Right now, chemotherapy is the most common treatment for SCLC. There are other options, like surgery and radiation, but they’re limited and their use is controversial.
In the last few years, several new treatments were approved by the FDA, including durvalumab (Imfinzi), a drug used along with chemotherapy, and lurbinectedin (Zepzelca), a new chemotherapy drug.
Many clinical trials in the works are studying treatments that may have better results for SCLC.
Here are some of the newest treatments.
A promising new treatment option for SCLC is targeted therapy. Targeted therapy works by attacking specific cancer cells or blocking certain molecules that develop into cancer with minimal to no harm to normal cells.
The benefit of targeted therapy is that it’s less toxic than standard treatments because it targets only the cancer cells or proteins involved in their growth. That may mean fewer side effects as well.
Targeted therapy is still being studied for what works and what doesn’t. Scientists are looking at which genes to target in SCLC and which targeted therapies may work best to treat it. So far, results have been mixed for different targeted therapy drugs.
Another advancement in the treatment of SCLC is immunotherapy. This treatment helps your immune system fight cancer. Your immune system detects and kills foreign invaders, including cancers. Cancers have evolved to be very good at evading our immune system. Immunotherapy tries to enhance your natural immune response to cancer.
For example, immune checkpoint inhibitors override your immune system's normal checks and balances so that your body creates an especially strong response to cancer cells.
Immunotherapy for SCLC includes drugs like:
- Atezolizumab (Tecentriq)
- Durvalumab (Imfinzi)
- Ipilimumab (Yervoy)
- Pembrolizumab (Keytruda)
Some experts believe immunotherapy is the most promising advancement in treating SCLC. But there’s still a lot that needs to be looked at. For example, its effectiveness is still relatively low. Standard care often is chemotherapy plus immunotherapy, but immunotherapy alone has only helped certain patients with SCLC.
Scientists hope to learn more about which patients may benefit from immunotherapy. To do this, they need to identify which biomarkers to look for that show the best results.
Clinical trials are looking at how these drugs may help with SCLC.
Research suggests that chest radiotherapy may be effective for treating stage IV SCLC that is otherwise controlled. Radiotherapy, also known as radiation therapy, uses high levels of radiation to shrink tumors and kill cancer cells.
Doctors now use more radiation therapy to treat SCLC. They may combine it with immunotherapy drugs like atezolizumab or durvalumab. They may use consolidative thoracic radiotherapy after chemotherapy to improve chances of survival.
Radiosensitizers are drugs that speed up DNA damage and make free radicals to help kill cancer cells. Researchers have been studying certain drugs as radiosensitizers to see if they help make radiation therapy for SCLC more effective. More research is needed.
Radiation therapy is still being studied to see if it’s safe and effective for SCLC. More research is needed to understand how to prevent tumors from relapsing.
Metronomic chemotherapy is also called low-dose chemotherapy. It involves a lower dose of cancer drug given over a longer period of time. You may take it frequently, like every day or every week, for a long period of time. Or you may take it on an ongoing basis.
This type of chemotherapy has fewer side effects than regular chemotherapy and may stop new blood vessels from growing, which may stop tumors from growing.
Early use of it as a secondary treatment for SCLC has had positive results. Doctors are looking at it more closely to find out more about its possible toxicity.
Lurbinectedin (Zepzelca) is a chemotherapy drug that damages the DNA of cancer cells and prevents them from dividing, which may ultimately kill the cancer cells. It may be used alone or with other drugs.
Lurbinectedin recently received a fast, provisional FDA approval to treat adults with metastatic SCLC. It’s for people who have SCLC that spread to other areas, then got worse when it was treated with platinum-based chemotherapy. Since the approval was provisional, it’s not covered by all insurance providers.
Lurbinectedin is still being studied for SCLC. The drug needs to show successful results from follow-up trials to be fully approved. Researchers are also studying it to see if it helps treat other types of cancers.
The Future of SCLC Treatment
More clinical trials are needed to better understand newer therapies like immunotherapy and other drugs.
Experts hope to learn more about different options for using these therapies, like which combinations work and how to predict which patients they’ll work best for.
There are many drugs being studied now, including newer, emerging drugs.
Even though progress has been somewhat slow over the last few decades, there’s now new activity that may lead to promising new ways of treating this aggressive form of lung cancer.
What You Can Do Now
With many clinical trials now in effect, there may be one you can get involved in. Some are funded by the U.S. government and others are supported by private sources.
For more information, talk to your doctor or go to clinicaltrials.gov. You can also find clinical trials at the NIH Clinical Center at cc.nih.gov. For details on privately funded clinical trials, go to centerwatch.com.
While clinical trials continue, you can get involved in advocacy efforts to help move SCLC advancements forward. The more people with SCLC who participate in research opportunities, the more we will learn about useful treatments.