Extensive Small Cell Lung Cancer

Overview

When small cell lung cancer has spread to both lungs or is detectable beyond the lungs, it is referred to as extensive.

A variety of factors ultimately influence a patient's decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient's chance of cure, or prolong a patient's survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of extensive small cell lung cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Patients with extensive disease small cell lung cancer are rarely curable with currently available standard treatment strategies although many patients experience a response to treatment.  Because the cancer has spread outside the chest, it cannot be eliminated with radiation or removed surgically. Currently the standard treatment for extensive small cell lung cancer is chemotherapy using a combination of chemotherapy drugs, typically cisplatin or carboplatin combined with etoposide or irinotecan.  Approximately 60%-80% of patients will experience a response to this chemotherapy and 15% to 20% of individuals respond completely.  Before chemotherapy was used, patients on average only survived approximately 1.5 months. Single-agent chemotherapy improved the average survival to four months and the development of combination chemotherapy regimens has further increased the average survival to approximately nine months with some patients surviving two years or longer.

Some patients with extensive small cell lung cancer also receive radiation therapy. Radiation therapy can reduce symptoms from cancer that has spread outside of the lungs, and also helps to manage cancer that has spread to the brain (brain metastases). Radiation therapy to the head may also be used preventively to reduce the likelihood of brain metastases. This preventive treatment—called prophylactic cranial irradiation—is usually reserved for patients who have had a good response to chemotherapy.

Strategies to Improve Treatment

While some progress has been made in the treatment of small cell lung cancer, better treatment strategies are clearly needed, as the majority of patients still experience disease recurrence. The progress that has been made in the treatment of small cell lung cancer has resulted from the development of multi-modality treatments, new anti-cancer agents and participation in clinical trials. Future progress in the treatment of small cell lung cancer will result from continued participation in appropriate clinical trials. There are several areas of active exploration aimed at improving the treatment of small cell lung cancer.

New Combination Chemotherapy Regimens:  Clinical trials continue to evaluate new drugs and new combinations of drugs in an effort to improve upon the treatment results achieved with standard chemotherapy regimens.

Targeted Cancer Therapies: Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival. Some targeted therapies block growth signals from reaching cancer cells; others reduce the blood supply to cancer cells; and still others stimulate the immune system to recognize and attack the cancer cell. Depending on the specific “target,” targeted therapies may slow cancer cell growth or increase cancer cell death. Several different types of targeted therapies are being evaluated for the treatment of small cell lung cancer.

High-Dose Chemotherapy: High-doses of chemotherapy are more effective at killing cancer cells than lower doses. However, high-dose chemotherapy (HDC) destroys many other cells in the body, including stem cells. Stem cells are immature blood cells produced in the bone marrow which mature into either red blood cells, which carry oxygen to tissues; white blood cells, which fight infection; and platelets, which aid the blood in clotting. A stem cell transplant (SCT) is a procedure that replaces the stem cells that are destroyed by high-dose chemotherapy and/or radiation therapy with healthy stem cells. There are two main types of stem cell transplants. Autologous stem cell transplants use a patient’s own stem cells, which are collected prior to the high-dose treatment and then re-infused after the treatment. Allogeneic stem cell transplants use stem cells collected from the blood or bone marrow of a related or unrelated donor.

Early attempts at using very high doses of chemotherapy and bone marrow transplant produced very high cancer response rates, but the treatment was associated with significant side effects. In the 1990s, several technologic advances have made high-dose chemotherapy safer and easier to deliver. This treatment approach continues to be evaluated at some cancer centers. To learn more, go to Stem Cell Transplantation.