Small Cell Lung Cancer Treatment Professional Information

Treatment Option Overview

Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. Refer to the PDQ levels of evidence summary for more information.

In small cell lung cancer, the majority of patients die of their tumor despite state-of-the-art treatment. Most of the improvements in survival in small cell lung cancer are attributable to clinical trials which have attempted to improve on the best available, accepted therapy. Patient entry into such studies is highly desirable.

Methods under clinical evaluation in small cell lung cancer include adding chest radiation to chemotherapy regimens, varying drug doses in current regimens, alternating different combinations of chemotherapy, using different schedules of chemotherapeutic agents, and using new drug regimens composed of standard and new agents.

Prospective randomized trials have not demonstrated a consistent survival advantage for patients treated with higher doses of chemotherapy.^1,2 One retrospective review of chemotherapy trials did not show consistent evidence for improved response rates or survival with more dose-intense chemotherapy regimens.³[Level of evidence: 1iiA] Even chemotherapy of the intensity used in autologous bone marrow transplant regimens has not clearly been shown to improve survival in patients with small cell lung cancer.⁴

The designations in PDQ that treatments are "standard" or "under clinical evaluation" are not to be used as a basis for reimbursement determinations.

References:

1. Ihde DC, Mulshine JL, Kramer BS, et al.: Prospective randomized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small-cell lung cancer. Journal of Clinical Oncology 12(10): 2022-2034, 1994.
2. Arriagada R, Le Chevalier T, Pignon JP, et al.: Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. New England Journal of Medicine 329(25): 1848-1852, 1993.
3. Klasa RJ, Murray N, Coldman AJ: Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. Journal of Clinical Oncology 9(3): 499-508, 1991.
4. Elias AD, Ayash L, Frei E, et al.: Intensive combined modality therapy for limited-stage small-cell lung cancer. Journal of the National Cancer Institute 85(7): 559-566, 1993.

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