Ask the Experts Archive > Types of Cancer > Lung Cancers > Small-Cell Lung Cancer

Third line treatment for small cell lung cancer

Affiliation: Abramson Cancer Center of the University of Pennsylvania
Last Modified: March 16, 2003

Dear OncoLink "Ask The Experts,"
I was diagnosed with small cell lung cancer and metastasis to the liver. After a couple of sessions of Topotecan and Taxol, I improved, but later on my condition worsened. My chemo was changed several months ago to Cisplatin and Camptosar, which seemed to improve me a lot. However, in the last month I became worse, a fact corroborated by CT scans. I'm now waiting for my oncologist to decide what to do. But my question to you is: Are there other chemotherapy treatments, which could be prescribed in cases like mine?  

Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, responds:

When you were first diagnosed with small cell lung cancer it had spread to your liver. It sounds like you had a very good response to your initial chemotherapy with taxol and topotecan. This is what usually happens with this type of cancer. The majority of cases respond initially to chemotherapy, sometimes dramatically. However, unfortunately, when the cancer has spread outside of the chest at diagnosis, it almost invariably recurs, and then it becomes more difficult to treat.

In your case, when the cancer started to grow again, you were treated with two drugs that are very active in small cell lung cancer, camptosar and cisplatin. Again, the cancer responded, but unfortunately it is now growing again. Responses to second line chemotherapy are generally not as dramatic as initial responses and do not last as long. This is because the cancer cells become resistant to chemotherapy-not just the drugs that have already been used, but also to other structurally and functionally unrelated drugs. This is a phenomenon called "multidrug resistance". Scientists have come a long way in understanding how cancer cells become multidrug resistant, but unfortunately we do not yet have any clinically effective medications for overcoming this resistance.

Did your cancer start to grow again while you were still receiving chemotherapy? If this is the case the chances of responding to other chemotherapy drugs are quite low. If you have been off chemotherapy for a few months, then the chances of response to further treatment are a bit better, although the tumor is not likely to respond as well as to previous treatments. There are a number of other drugs with activity in small cell lung cancer, including etoposide (VP-16, Vepesid) and Gemcitabine (Gemzar^®). If you are feeling well enough, it may be worth trying further chemotherapy. If you respond again, there may be some improvement in your symptoms as well as some prolongation of your life.

If you do not have further chemotherapy or if further treatment is not effective, you should talk to your doctor about what can be done to make you more comfortable and control pain or whatever symptoms that you may be having. Even when chemotherapy does not help there is usually something positive that can be done to relieve the symptoms of this difficult disease.