Small-cell lung cancer: current therapy and novel agents

Among patients with lung cancer, approximately 15% have small-cell lung cancer (SCLC). Although, without therapy, untreated SCLC is a rapidly proliferating tumor with a poor prognosis, response rates to chemotherapy and radiotherapy are high. SCLC is usually staged as either limited disease or extensive disease. Extensive disease is treated primarily with chemotherapy. A recent Japanese randomized trial compared IP (irinotecan [Camptosar]/cisplatin [Platinol]) with EP (etoposide/cisplatin). Patients in the IP arm had significantly better outcomes than patients in the EP arm. In the IP arm, the response rate was 84%, and the median overall survival period was 12.8 months. Limited disease is usually treated with concurrent chemotherapy and accelerated radiation therapy, and approximately 20% of patients are cured. Further investigations to improve local control and inhibit distant metastasis are clearly warranted. The dose-rate escalation in radiotherapy (administered concurrently with chemotherapy) is important in improving local control, and the introduction of molecular-targeting agents is necessary to inhibit distant metastasis.