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Currently available standard treatments for small cell lung cancer (SCLC) are far from optimal as evidenced by the fact that few patients achieve a complete cure with the standard treatment regimens that are available today. The median survival rate for patients with limited-stage disease is 18 months and less than 12 months for those with extensive-stage disease. Because small cell lung cancer is a very aggressive disease that is rapidly fatal in most patients, researchers are focusing on developing novel treatments in hopes of prolonging survival and improving quality of life. Some of the novel treatments for SCLC currently under investigation are discussed briefly in this section of the Guidebook.

Neuropeptide Receptor Inhibitors

Researchers have identified numerous neuropeptides (compounds found in nerve tissues that have potent effects on various biochemical processes in the body) that are thought to play an important role in small cell lung cancer by stimulating the growth of cancer cells. Drugs that can block the action of the neuropeptides can, theoretically, inhibit the growth and spread of small cell lung cancer. Examples of drugs under investigation that are designed to target and inhibit neuropeptides or its receptors include:

• BW 2258U89
• Antagonist D
• Antagonist G
• CU 201

Imatinib mesylate (Gleevec)

Imatinib mesylate (Gleevec) is a drug that is currently used for the treatment of chronic myelogenous leukemia. Laboratory studies have shown that imatinib mesylate can also inhibit the growth of tumor cells obtained from patients with small cell lung cancer. This finding has prompted researchers to further investigate the potential usefulness of this drug for the treatment of SCLC.

Fenretinide (4-HPR)

Fenretinide (4-HPR) is a synthetic retinoid compound that has been shown in laboratory studies to inhibit the growth of cancer cells from patients with small cell lung cancer.

Oblimersen (Genasense; G3139)

Studies have shown that the cells of most patients with small cell lung cancer overproduce an oncogene called bcl-2. An oncogene is a gene that is involved in controlling the growth of cancer cells. Overproduction of the bcl-2 oncogene is believed to play a role in the growth and spread on SCLC. Oblimersen is a drug that belongs to a family of compounds called antisense oligonucleotides and is designed to block the overproduction of the bcl-2 oncogene.

Exisulind (Aptosyn)

Exisulind (Aptosyn) has been shown to be effective for shrinking colonic polyps in patients with familial adenomatosis polyposis and is currently being evaluated in clinical trials for the treatment of a variety of cancers, including small cell lung cancer.

Bortezomib (Velcade; PS341)

Bortezomib (Velcade; PS341), which has recently been approved for the treatment of multiple myeloma, enhances the sensitivity of cancer cells to chemotherapy.

CCI -779 (Temsirolimus)

CCI -779 (Temsirolimus), which inhibits a specific phase in the growth cycle of cancer cells, is currently being evaluated for the treatment of a variety of cancers including extensive-stage SCLC.

Interferon

Interferons are a member of a group of biological substances called cytokines that have been studied extensively as adjuvant treatment of various cancers because of their unique anti-cancer properties. Although a few small studies conducted in Europe reported a survival advantage for patients with small cell lung cancer who were treated with interferon alpha-2a, these results could not be duplicated in a Phase II clinical trial conducted in 1998 in the United States. Currently, researchers are evaluating the effect of interferon alpha-2a in conjunction with other biological and chemotherapeutic agents for the treatment of extensive-stage SCLC.

Tumor Vaccines