New perspectives in therapy of small cell lung cancer

Small cell lung cancer (SCLC) displays many unique features which are not present in the other subtypes of lung cancer. The clinical presentation with its unique paraneoplastic syndrome and early metastatic spread make SCLC a protean diagnostic problem. Until recently, SCLC was considered to have the worst prognosis in lung cancer. However the natural history of this cancer has been altered substantially over the past ten years with the application of combined modality therapy using combination chemotherapy and radiation therapy. Numerous clinical trials have demonstrated the four to five fold improvement in survival for patients with limited disease treated with combination chemotherapy and radiation therapy. There are several active chemotherapeutic agents such as cyclophosphamide, doxorubicin, etoposide, vincristine, methotrexate and cisplatinum which are currently used in various combination regimens. The role of radiation therapy is undergoing changes with an improvement in results when used in combination with chemotherapy. It no longer plays a primary role but remains a valuable adjunct in the management of small cell lung cancer. There is a diminishing role for surgery in this type of lung cancer. The therapeutic progress in SCLC has reached a plateau in the past four to five years. However much progress has been made in understanding the biology of SCLC. Armed with a better understanding of the biology of SCLC, we can hopefully formulate better treatment regimens and ultimately further improve therapeutic results.