• Cheng S, Evans WK, Stys-Norman D, Shepherd FA, Lung Cancer Disease Site Group. Chemotherapy for relapsed small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Aug 2. 21 p. (Evidence-based series; no. 7-17). [13 references]

• The evidence for the clinical benefit of second-line chemotherapy in the treatment of patients with relapsed small cell lung cancer (SCLC) is limited. The selection of patients for treatment with second-line therapy should be dependent on the treatment-free interval, the extent of response to first-line therapy, residual toxicity from first-line therapy, and the performance status of the patient.
• There is insufficient evidence to recommend a specific chemotherapy regimen. However, in the opinion of the Lung Cancer Disease Site Group, patients who relapse three or more months following the completion of first-line chemotherapy may benefit from retreatment with the same regimen that induced their initial response. This would generally mean retreatment with etoposide-cisplatin. Alternative regimens may include cyclophosphamide, doxorubicin, and vincristine (CAV) or carboplatin and etoposide.
• Oral topotecan is a possible alternative for patients who initially responded to chemotherapy and had a response duration of 45 days or longer.
• There is insufficient evidence to determine whether one mode of administration of topotecan is superior to any other mode of administration. Oral administration is more convenient and may be a treatment option for patients not suitable for intravenous therapy. Oral administration is associated with a higher incidence of grade 3/4 diarrhea, whereas intravenous administration may result in a higher frequency of grade 3/4 neutropenia.
• There is currently no standard second-line chemotherapy regimen for patients who fail to respond to or who relapse shortly after first-line therapy. Clinical trials are needed to determine the optimal treatment regimen.

None provided

The recommendations are supported by randomized trials.

• Cheng S, Evans WK, Stys-Norman D, Shepherd FA, Lung Cancer Disease Site Group. Chemotherapy for relapsed small cell lung cancer: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Aug 2. 21 p. (Evidence-based series; no. 7-17). [13 references]

Not applicable: The guideline was not adapted from another source.

2006 Aug 2

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Provincial Lung Cancer Disease Site Group

The members of the Lung Disease Site Group (DSG) declared that there were no potential conflicts of interest relating to the topic of this evidence-based series.

None available

This NGC summary was completed by ECRI on October 26, 2006. The information was verified by the guideline developer on November 24, 2006.