Chemotherapy of small cell lung cancer

Selection of appropriate treatment is now possible on the basis of prognostic indices. For patients with a "poor" prognosis, therapy should be minimally toxic, for palliative purposes only. For patients with a "good" prognosis, intensive treatment is recommended with combinations comprised from C, A, V, VP-16, and CP. For patients obtaining a remission, consolidation is recommended with radiation treatment if this has not been part of the initial induction program with or without chemotherapy. Consolidation may be intensified by using high-dose chemotherapy in association with autologous bone marrow transplantation or possibly the use of hematopoietic growth factors. The major problem limiting further improvements in survival in this disease remains the emergence of drug resistance, which is now the subject of intensive investigations both in the laboratory and in the clinic.