Palliative therapy: extensive small cell lung cancer

During the past two decades advances have been made in the systemic treatment of small cell lung cancer. Chemotherapy will produce objective responses in the majority of patients, yet few patients with extensive disease have prolonged survival. Combination regimens like cyclophosphamide/doxorubicin/vincristine, cisplatin/etoposide, and cisplatin/etoposide/ifosfamide have produced objective responses in 55% to 65% of patients. Recent clinical trials with single-agent chemotherapy suggest median lengths of survival that appear comparable to that obtained with combination therapy. Such approaches may be appropriate for elderly patients and will be evaluated in a prospective randomized trial. Ultimately, to provide the maximum palliative benefit for patients with extensive small cell lung cancer, the therapeutic benefit must be balanced against the costs of treatment (physical, psychological, and financial).