MedifocusHealth

Platinum-based combination chemotherapy represents the first-line treatment for patients with small cell lung cancer (SCLC). The most widely used chemotherapeutic regimen in the United States is cisplatin and etoposide (PE), however, in many cases, carboplatin may be substituted for cisplatin because it appears to be just as effective but is associated with fewer side-effects. The cisplatin (or carboplatin) plus etoposide regimen has largely replaced the older cyclophosphamide, doxorubicin, and vincristine (CAV) drug regimen that was widely used in the 1980s for the treatment of SCLC. Regimens containing irinotecan are also increasing in popularity for initial or subsequent treatment of small cell lung cancer based on encouraging efficacy data.

Other chemotherapeutic drugs that may be used for treatment of patients with small cell lung cancer include:

• Docetaxel
• Paclitaxel
• Teniposide
• Lomustine
• Vinorelbine
• Topotecan
• Gemcitabine
• Ifosfamide

Patients with limited-stage SCLC usually receive 4 to 6 cycles of platinum-based combination chemotherapy with cisplatin (or carboplatin) plus etoposide. Concurrently, they also receive thoracic (chest) radiation therapy which is usually initiated at the first or second cycle of chemotherapy. Studies have shown that the 5-year cancer-free rate for patients with limited-stage SCLC who were treated with cisplatin/etoposide plus thoracic radiation therapy was about 25%.

Platinum-based combination chemotherapy is also considered as the first-line treatment for patients with extensive-stage SCLC. Again, the most commonly used regimen is cisplatin/etoposide, however, carboplatin may be substituted for cisplatin.

A recent clinical trial conducted in Japan compared cisplatin/etoposide to cisplatin/irinotecan and reported longer survival rates for patients with extensive-stage SCLC who were treated with the cisplatin/irinotecan regimen. This data is encouraging, and, while additional studies are needed, irinotecan-based regimens continue to increase in popularity. However, cisplatin/etoposide currently remains the chemotherapeutic regimen of choice in the United States for the treatment of extensive-stage SCLC.

The role of radiation therapy for patients with extensive-stage SCLC is usually limited to palliative relief of symptoms associated with the spread of the disease to other areas of the body (distant metastases). Palliative radiation therapy may be considered for patients with extensive-stage SCLC who present with:

• Bone pain due to metastases of the cancer to bone
• Impending bone fracture due to loss of bone
• Spinal cord compression from the tumor
• Symptoms of brain metastases as evidenced by cranial imaging