Current management of small cell lung cancer

There will be approximately 45,000 new cases of small cell lung cancer (SCLC) this year. Despite the initial sensitivity to chemotherapy, only 10% of all SCLC patients will have significant long-term survival. Studies have yet to show significant survival advantage for maintenance chemotherapy, and it appears that four to six cycles of chemotherapy is as effective as longer durations of chemotherapy. There is as yet no defined role for dose increase in the treatment of SCLC. In extensive disease no one chemotherapy combination has shown a definitive survival advantage, although it appears that single-agent oral etoposide may be inferior to combination intravenous chemotherapy. In limited disease, however, cisplatin plus etoposide alone or in alternation with cyclophosphamide, doxorubicin, and vincristine is superior to other approaches. Also, in limited disease, chemotherapy plus radiotherapy is superior to chemotherapy alone and it appears that early concurrent radiotherapy may be the ideal approach. Myeloid growth factors should not be given concurrently with thoracic radiotherapy. There are several new agents with significant activity in SCLC awaiting further study.