Overview of chemotherapy for small cell lung cancer

Small cell lung cancer (SCLC) accounts for 20% to 25% of all lung cancer cases in developing countries. The incidence of and mortality from SCLC continues to increase in these countries, especially in females. Small cell lung cancer is different from other lung cancer histologic types in that it has neuroendocrine features, grows more rapidly, spreads earlier, is more responsive to chemotherapy and radiotherapy, and has a lower cure rate. Because of the propensity to metastasize early, the lack of screening modalities, and the sensitivity to chemotherapy, the cornerstone of treatment is combination chemotherapy, which is indicated in all SCLC patients able to tolerate any therapy. Patients with extensive-stage SCLC generally receive combination chemotherapy alone. Most patients with limited-stage SCLC should be treated with combined modality therapy consisting of chemotherapy and chest radiotherapy. In the rare patient with stage I SCLC and no involved lymph nodes, surgical resection with chemotherapy provides a high rate of long-term survival. Several combinations are used routinely, including the two-drug combination of etoposide with cisplatin or carboplatin, which is used most frequently in the United States. There is no proven role for any type of maintenance therapy, for intensive chemotherapy, or for biological therapies. There have been no major advances in therapy in the last decade, although the recent advent of new active agents, including gemcitabine, provides hope for more effective therapies in future years. This report will review the past literature on SCLC therapy.