[The place for therapeutic intensification in small cell lung cancer]

Therapeutic intensification of small cell lung cancer (SCLC) relies on either the simultaneous and repeated administration of a greater number of drugs without cross-resistance, or to the use of classical combinations with greater intensity, either by increasing the doses in each cycle or by reducing the intervals between cycles. The authors review the trials concerning disseminated SCLC: eight randomised studies have compared a standard regimen with an intensified regimen: only one has demonstrated a benefit in terms of survival with the intensified regimen. They will then discuss the problem of intensification of the chemotherapy in the particular case of localised SCLC, which requires the combination of chemotherapy and thoracic radiotherapy: two studies were in favour of the intensified regimen. Lastly, intensification, associating massive doses of polychemotherapy with autologous bone marrow graft or re-injection of hematopoietic stem cells, increases the response rate at the price of a significant increase in toxicity and costs, without benefit in terms of survival.