Future directions in the management of small cell lung cancer

The treatment of small cell lung cancer (SCLC) has continued to evolve over the past 20 years and now consists primarily of combination chemotherapy with or without thoracic radiotherapy depending on stage at presentation. However, despite marked improvement in overall survival, a majority of patients continue to die of their disease. It is not likely that conventional chemotherapy agents will substantially alter this dismal fact but new agents are available with novel mechanisms of action some of which yield excellent response rates. The agents with greatest promise include the taxanes and drugs that target topoisomerase I. Real progress in the management of SCLC will come with the identification of methods for overcoming drug resistance, exploration of new treatment strategies including gene therapy and possibly through the use of biological agents. Chemoprevention trials are of the utmost importance given the high incidence of second primary tumors that arise in the few long term survivors of this disease. All these areas are fertile grounds for future investigation in the management of SCLC.