Current status of therapy for small cell carcinoma of the lung

Abstract

Small cell carcinoma of the lung (SCCL) is distinguished from other types of lung cancer by its propensity for early development of distant metastases and its rapidly fatal clinical course in the absence of treatment. The introduction of chemotherapy into the management of SCCL has led to a four‐ to five‐fold improvement in median survival and to the cure of a small proportion of patients with this disease. Employment of three‐ or four‐drug regimens with or without chest irradiation in moderately intensive doses for periods of 12 months or less has proven to be the optimal therapeutic strategy with currently available agents. Despite these substantial gains, it is obvious that the vast majority of SCCL patients are continuing to die from their cancer, and a slowing in the pace of treatment advances has become apparent over the past 5 years. This article reviews current areas of active clinical investigation in SCCL and some information developed in the cell biology laboratory that may have eventual application in the clinic.

Extrapulmonary and pulmonary small‐cell carcinoma: Tumor biology, therapy, and outcome

“…Therapy alters the natural history of this disease. For patients with limited disease the overall objective response rate approaches 80% with a complete response rate of between 50 and 60%, and median survival is between 12 and 20 months [84,85]. Patients with extensive disease do not do as well.…”

“…Overall objective and complete response rates are 7.5%) and 1 5 3 0 % respectively. Median survival of extensive disease small-cell lung cancer is between 7 and 12 months [84,85] (see Table I). A small percentage of patients, 10-1.5%, with limited disease small-cell lung cancer, however, will survive free of disease for 2 years or more and some will be cured [8&88].…”

Limitations of the Fast Green Assay for Chemosensitivity Testing in Human Lung Cancer

“…[2][3][4] In small-cell lung cancer (SCLC), most patients show impressive responses to combination chemotherapy regimens. 5 However, in the vast majority of patients, the tumor relapses, and not all patients will benefit from second-line treatment. 6 Thus, selection of patients with inoperable lung cancer who are most likely to have any benefit of chemotherapeutic treatment would constitute a substantial step forward.…”

Small cell carcinoma versus other lung malignancies

“…SMC is an aggressive tumor with a tendency to metastasize early. It has a reduced survival time if untreated but is highly responsive to chemotherapy 5, 6. While chemotherapy, with or without radiation, is the first treatment modality used in SMC, surgery is the modality of choice for low‐stage bronchogenic non‐small cell carcinomas and a few histologic types of metastatic neoplasms.…”