Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)

The majority of patients with small cell lung cancer (SCLC) die of their tumor despite the best available treatment. Most of the improvements in the survival of patients with SCLC are attributable to clinical trials that have attempted to improve on the best available and most accepted therapy. Patient entry into such studies is highly desirable.

Treatments under clinical evaluation in SCLC include studies of the timing of thoracic radiation therapy (for patients with limited-stage disease) and studies evaluating the role of surgery for stage I patients in conjunction with varying drug doses in current regimens, using different schedules of chemotherapeutic agents, and using new drug regimens composed of standard and new agents.[1] Information about ongoing clinical trials is available from the NCI Web site.

Chemotherapy improves the survival of patients with limited-stage or extensive-stage SCLC, but it is curative in only a minority of patients.[1,2] Prospective randomized trials have not demonstrated a consistent survival advantage for patients treated with higher doses of chemotherapy.[3,4] One retrospective review of chemotherapy trials did not show consistent evidence for improved response rates or survival with more dose-intensive chemotherapy regimens.[5][Level of evidence: 1iiA] Even chemotherapy of the intensity used in autologous bone marrow transplant regimens has not clearly been shown to improve survival in patients with SCLC.[6] An intergroup study that compared the combination of dose-intensive cisplatin, vincristine, doxorubicin, and etoposide with standard doses of cyclophosphamide, doxorubicin, vincristine/etoposide, and cisplatin found that the more dose-intensive regimen produced a higher response rate but at the cost of increased treatment-related mortality and did not result in improved progression-free or overall survival.[7][Level of evidence: 1iiA]

References

1. Comis RL, Friedland DM, Good BC: Small-cell lung cancer: a perspective on the past and a preview of the future. Oncology (Huntingt) 12 (1 Suppl 2): 44-50, 1998.  [PUBMED Abstract]
   
   
2. Agra Y, Pelayo M, Sacristan M, et al.: Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database Syst Rev (4): CD001990, 2003.  [PUBMED Abstract]
   
   
3. Ihde DC, Mulshine JL, Kramer BS, et al.: Prospective randomized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small-cell lung cancer. J Clin Oncol 12 (10): 2022-34, 1994.  [PUBMED Abstract]
   
   
4. Arriagada R, Le Chevalier T, Pignon JP, et al.: Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. N Engl J Med 329 (25): 1848-52, 1993.  [PUBMED Abstract]
   
   
5. Klasa RJ, Murray N, Coldman AJ: Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung. J Clin Oncol 9 (3): 499-508, 1991.  [PUBMED Abstract]
   
   
6. Elias AD, Ayash L, Frei E 3rd, et al.: Intensive combined modality therapy for limited-stage small-cell lung cancer. J Natl Cancer Inst 85 (7): 559-66, 1993.  [PUBMED Abstract]
   
   
7. Murray N, Livingston RB, Shepherd FA, et al.: Randomized study of CODE versus alternating CAV/EP for extensive-stage small-cell lung cancer: an Intergroup Study of the National Cancer Institute of Canada Clinical Trials Group and the Southwest Oncology Group. J Clin Oncol 17 (8): 2300-8, 1999.  [PUBMED Abstract]
   
   

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