Treatment for Small Cell Lung Cancer
My mother was recently diagnosed with extensive stage small cell lung cancer and has been offered chemotherapy with cisplatin and VP-16. What is the most up to date treatment for this disease?
Barbara Campling, MD, Medical Oncologist at the Abramson Cancer Center of the University of Pennsylvania, responds:
Small cell lung cancer occurs almost exclusively in smokers or former smokers, and it now comprises about 13% of all lung cancers. It differs from the more common "non-small cell lung cancer" in that it grows and spreads more quickly, but is usually much more responsive to chemotherapy.
The majority of cases of small cell lung cancer are classified as "extensive stage" at diagnosis. This means that the cancer has spread outside a localized area within the chest, often to other parts of the body. Unfortunately, we do not have any treatments available which can cure extensive stage small cell lung cancer.
Chemotherapy is the major form of treatment, and the good news is that most cases respond, sometimes dramatically. Chemotherapy is usually very effective in relieving symptoms and improving survival. However, inevitably the cancer will eventually become resistant to further therapy.
Despite intensive clinical research, there have been no major breakthroughs in the chemotherapy of small cell lung cancer in over two decades. Most centers in North America use a combination of a "platinum" drug (either cisplatin or carboplatin) along with etoposide (also known as VP-16). This is what has been offered to your mother, and this is what we would recommend.
Despite the lack of new and improved chemotherapy, there has been some recent progress in the treatment of extensive stage small cell lung cancer. A recent study showed that "prophylactic cranial radiation", when given to patients with extensive stage small cell lung cancer after response to chemotherapy, not only reduces the chance of the cancer recurring in the brain, but also improves survival (1). After many years of negative clinical studies in this disease, oncologists are quite excited about this.
(1) Slotman et al, New England Journal of Medicine (2007) 357:664-672.