Treatment Options for Extensive Stage Small-Cell Lung Cancer

Medically Reviewed by Laura J. Martin, MD on April 07, 2020

About 2 out of 3 people with small-cell lung cancer (SCLC) have extensive-stage disease when doctors first find their cancer. This means the condition has spread to the other side of your chest or another place in your body, such as the liver, bones, brain, or adrenal glands. 

While surgery usually isn’t an option if you have extensive SCLC, treatments are available to relieve symptoms and extend your life.

Common Treatments for Extensive SCLC

Some options include:

Chemotherapy and immunotherapy. Chemo is usually the treatment of choice for healthy people with extensive SCLC. Your doctor may recommend chemo along with an immunotherapy medicine, which helps your body’s immune system fight cancer.

Doctors use the following combinations:

  • The chemo drug etoposide is frequently given with the chemo drugs cisplatin or carboplatin.
  • The immunotherapy drug atezolizumab (Tecentriq) can be given with etoposide and carboplatin at first and then continued alone as maintenance therapy.
  • The immunotherapy drug durvalumab (Imfinizi) is sometimes combined with etoposide and carboplatin.

Additionally, two new drugs have recently shown promise for people with extensive SCLC whose cancer advances after standard treatment:

  • The immunotherapy drugs nivolumab (Opdivo) and pembrolizumab (Keytruda) may be options for people whose cancer has progressed after chemo and at least one other line of therapy.

Radiation. If your cancer responds well to chemo and immunotherapy, your doctor may recommend radiation therapy to the brain to lessen the chances that the cancer will spread there. You might also receive radiation to the chest. Studies show this treatment might help people with extensive SCLC live longer. You can also have radiation therapy for other areas of your body where the cancer has spread to relieve symptoms and improve your quality of life.

Laser surgery. If your cancer causes bleeding or shortness of breath, laser surgery may help relieve these symptoms. This treatment uses a laser beam to kill diseased cells.

Palliative Care for Extensive SCLC

Palliative care is an important supportive approach that can help control your pain and improve your well-being.

As part of palliative care, you may receive standard treatments along with pain-relieving medicines, supplemental oxygen, nutritional guidance, massage, occupational therapy, spiritual counseling, integrative treatments, and more.

Specifically, palliative methods can help improve:

  • Shortness of breath
  • Fatigue
  • Nausea
  • Constipation
  • Loss of appetite
  • Anxiety and depression

You’ll probably have an entire palliative care team that works with your primary doctor. This may include doctors, nurses, social workers, psychologists, nutritionists, counselors, chaplains, pharmacists, and others.

How to Decide on a Treatment

It’s important to understand the goals of your treatment. If you have extensive SCLC, current therapies likely won’t cure your cancer. Instead, your doctor will use them to slow the growth of tumors, prolong your life, and relieve any symptoms you have.

Your doctor can help you decide on which treatment is best.

Options may depend on:

  • Your overall health
  • How much your cancer has spread
  • Other medical conditions you have
  • Your personal preferences

Clinical Trials for Extensive SCLC

Researchers are testing newer therapies for extensive SCLC in clinical trials. These studies take place in medical centers around the country. To learn more about clinical trials, talk to your doctor.

Tips for Living Well With Extensive SCLC

These lifestyle habits may help you feel better and live well:

  • Eat a healthy diet that includes lots of fruits and veggies.
  • Exercise daily if you can.
  • Try a complementary approach, such as meditation, yoga, or massage.
  • Ask your doctor about a pulmonary rehabilitation program that may help you breathe better.
  • Get enough sleep each night.
  • Rest during the day when you’re tired.
  • Join a support group so you can connect with others who understand your situation.

Show Sources


American Cancer Society: “Small Cell Lung Cancer Stages,” “Treatment Choices for Small Cell Lung Cancer, by Stage.”

UpToDate: “Patient education: Small cell lung cancer treatment (Beyond the Basics).”

National Cancer Institute: “Small Cell Lung Cancer Treatment (PDQ®)–Health Professional Version,” “Small Cell Lung Cancer Treatment (PDQ®)–Patient Version.”

Lungevity: “Treatment Options for Small Cell Lung Cancer by Stage,” “Living Well With Lung Cancer.”

American Lung Association: “Supportive (Palliative) Care for Lung Cancer.”

New England Journal of Medicine: “Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.”

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