[Dose-effect of chemotherapy in bronchial small-cell cancer]

Treatment of patients with small-cell lung cancer (SCLC) remains disappointing despite high initial complete response rate. The dramatic initial chemosensitivity of tumor cells is frustrated by the early emergence of drug resistant clonogenic cells, regardless of front line treatments. Enhancement of dose-intensity (DI) can be achieved by various strategies: initial or late intensive chemotherapy with the use of hematological supports, moderate increase in the initial dose of chemotherapy or intensive weekly chemotherapy. Although the dose relationship is fairly well established regarding the response rate, the effect of DI on survival is not clearly shown in most of the different trials. But the effect of a moderate increase in the initial dose of cisplatinum and cyclophosphamide on survival, opens new directions in the therapeutic strategy of SCLC. The contribution of hematopoietic growth factors and reinfusion of hematopoietic progenitors may be of great interest in the management of this disease.