Treatment of patients with small-cell lung cancer: from meta-analyses to clinical practice

Despite decades of intensive biological and clinical research, there still remains a substantial lack of consensus regarding the appropriate therapeutic management of patients with small-cell lung cancer (SCLC). Many randomized studies have been performed to identify the most effective treatment strategy, the best agents or treatment duration, the most appropriate dose and timing of radiotherapy and thus providing more reliable evidence for clinical practice. Unfortunately most of these trials reported contrasting results, and in several meta-analyses have been performed, with the intent to clarify the strategic approach for each issue. This review focuses on the contribution of the main meta-analyses in defining the standard approaches in the treatment of SCLC, discussing their real value and influence on every-day decision making. According to the results of available meta-analyses, platinum-based chemotherapy should be considered the standard of care for the treatment of SCLC. Cisplatin and carboplatin have shown similar efficacy, and the choice of the platinum compound for the treatment of patients with extensive stage SCLC should consider the expected toxicity profile, organ function, performance status, and comorbidities. Thoracic radiotherapy, administered early and in combination with chemotherapy, improves long-term results, although with higher toxicity. Prophylactic cranial irradiation in patients with limited disease obtaining response after induction treatment is a standard of care. Maintenance treatment, intensified chemotherapy and use of growth factors have not proven significant efficacy. Topotecan is effective as second-line treatment, although evidence on clinical benefit for patients relapsed after first-line is limited.