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Treatment Options for Small Cell Lung Cancer
Supportive Care and Palliative Treatments for Small Cell Lung Cancer
Although small cell lung cancer (SCLC) is extremely sensitive to both chemotherapy and radiation therapy, most patients relapse after treatment and long-term survival is uncommon. Moreover, many patients with small cell lung cancer are not suitable for chemotherapy and/or radiation therapy for various reasons including poor prognosis, significant co-morbid conditions, and previous failure to respond to treatment. For these patients, the goals of treatment are to control the symptoms, improve quality of life, and prolong survival. These types of treatments are referred to as palliative treatments.
The following types of supportive care and palliative treatments may be considered for patients with SCLC:
- Growth factors to prevent febrile neutropenia
- Prophylactic antibiotics to prevent infections
- Bisphosphonates to prevent or delay metastatic bone disease
- Recombinant erythropoietin for treatment of anemia/fatigue
- Prophylactic cranial irradiation to prevent spread of the cancer to the brain
Growth Factors
Granulocyte colony-stimulating factor (G-CSF) is a growth factor that promotes the formation of blood cells and is commonly used for the prevention and treatment of a condition known as febrile neutropenia. This is a potentially life-threatening condition characterized by dangerously low levels of white blood cells called neutrophils and fever. Because intensive dose chemotherapy can cause prolonged myelosuppression (suppression of the bone marrow's ability to produce red blood cells, white blood cells, and platelets), granulocyte colony-stimulating factor (G-CSF) may be used to reverse the myelosuppressive effects of chemotherapy.
Prophylactic Antibiotics
Cancer patients undergoing chemotherapy are at increased risk for developing infections. Prophylactic antibiotics may sometimes be given in combination with cancer chemotherapy in an attempt to prevent the development of infections, some of which can be potentially life-threatening.
Bisphosphonates for Bone Metastasis
Patients with small cell lung cancer are at risk for developing metastatic bone disease whereby cancer cells spread from the lungs to bone. This may cause severe bone pain and spinal cord compression. It has been estimated that approximately 20% to 40% of patients with extensive-stage SCLC develop metastatic bone disease. Recently, a class of drugs known as bisphosphonates have become available that can prevent or delay the complications of metastatic bone disease. Bisphosphonates have also been shown to relieve bone pain experienced by patients with metastatic bone disease.
Recombinant Erythropoietin for Anemia/Fatigue
Most cancer patients experience fatigue at some point during the course of their illness. Most often, fatigue is due to anemia (low numbers of red blood cells in the bloodstream). Anemia is a common side-effect of chemotherapy and has been estimated to occur in about 50% to 60% of lung cancer patients. In recent years, a drug called recombinant erythropoietin (rHu-Epo; Epoietin) has become widely used in cancer patients to prevent and treat anemia. The American Society of Clinical Oncology (ASCO) practice guidelines and those of the National Comprehensive Cancer Network (NCCN) recommend the use of erythropoietin as a treatment option for patients with chemotherapy-associated anemia with hemoglobin levels of 10-11 g/dL or less. A newer formulation of erythropoietin called darbepoietin is now available that is as safe and effective as erythropoietin but requires less frequent administration.
