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Although approximately 50% or more of patients with limited-stage small cell lung cancer (SCLC) and about 25% with extensive-stage SCLC will experience complete remission (CR) of their disease after undergoing treatment with induction chemotherapy, unfortunately, most of these patients will relapse within the first 12 months. When considering treatment options for patients with small cell lung cancer where the cancer recurs after induction chemotherapy has been completed, it is important to determine the time interval elapsed between the completion of induction chemotherapy and relapse of the cancer. Patients who relapse less than 3 months after completion of induction chemotherapy are designated as refractory to treatment, whereas, those who relapse after 3 months or longer are considered sensitive to treatment. This distinction is important from a clinical perspective because patients with refractory disease are less likely to respond to second-line chemotherapy than patients with sensitive disease.

Second-line chemotherapy treatment options for patients with recurrent small cell lung cancer include:

• Topotecan - currently, topotecan is the only single-agent chemotherapy that has been approved by the U.S. Food and Drug Administration (FDA) as second-line treatment for patients with sensitive, relapsed SCLC.

• Combination chemotherapy with CAV (cyclophosphamide, doxorubicin, and vincristine)

• Combination chemotherapy with other anti-cancer drugs:

  • etoposide plus irinotecan
  • cisplatin plus topotecan
  • etoposide plus hexmethylmelamine
  • irinotecan plus paclitaxel
  • carboplatin plus paclitaxel