[Dose intensity of chemotherapy in small-cell lung carcinoma]

Small cell lung cancer accounts for 20% of the primitive lung carcinomas. The pronostic is unfavourable, since two thirds of the patients present with extensive stage at diagnosis. The median survival without treatment is less than 3 months. Chemotherapy is the standard front line therapy. In selected patients, chest irradiation and so-called prophylactic cerebral irradiation are current options. Small cell lung cancer is a chemosensitive disease. Indeed, the response rate is around 80-95% of in limited disease patients of which 50-60% are complete responses. Despite these results, the median survival does not exceed 16 months. Early recurrences after initial response probably reflect various resistances mechanisms. Furthermore, small cell lung cancer is associated with a high fraction of dividing cells. It is a clinical model where the dose-response relationship concept is worth testing, and dose-intensity may be integrated into the therapeutic strategies. Therefore, many clinical trials have assessed these principles during the past 20 years. We present here the different methods of therapeutic intensification in small cell lung cancer: with or without hematopoïetic supports, using initial high dose of cytotoxic drugs, either at the beginning or at the end of induction treatment, or by increasing the dose-density.