Small Cell Lung Cancer: Have We Made Any Progress Over the Last 25 Years?

Abstract

After completing this course, the reader will be able to:1. Discuss the currently available SCLC treatment options.2. Describe the benefits of integrating thoracic radiotherapy into SCLC treatment.3. Identify the limitations of current SCLC treatment options and explain how future clinical trials are addressing these limitations.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTTwenty-five years ago, small cell lung cancer was widely considered to be the next cancer added to the list of "curable cancers." This article attempts to summarize the progress made toward that goal since then. Clinical trials have provided landmarks in the therapy of limited-stage small cell lung cancer (LS-SCLC). These are: (a) the proof that thoracic radiation therapy adds to systemic chemotherapy, (b) the superiority of twice-daily radiation therapy over daily fractionation, and (c) the need for prophylactic central nervous system radiation (prophylactic cranial irradiation). Each of these innovations adds about 5%-10% to the overall survival rate. In extensive-stage disease, irinotecan plus cisplatin may be a possible alternative to the "standard" etoposide-cisplatin chemotherapy doublet, but there has been little progress otherwise. It is imperative that, whenever possible, patients be given the opportunity to participate in future clinical trials so that the survival for these patients can continue to improve. The Oncologist 2007;12:1096 -1104

Inhibition of PI3K/BMX Cell Survival Pathway Sensitizes to BH3 Mimetics in SCLC

“…Without treatment, median overall survival (OS) of SCLC patients is 2 to 4 months (4). Treatment increases median OS to 8 to 20 months (5). Although approximately 80% patients initially respond to chemotherapy, virtually all relapse with progressive disease within 3 to 18 months (5-7).…”

“…The molecular mechanisms underlying this acquired drug resistance are poorly understood (8). Approximately 20% patients are classified as chemorefractory with disease progression within 90 days of completing chemotherapy (5,7). Multiple targeted therapies have been evaluated in SCLC, none improved patient outcomes (9), and SOC chemotherapy remains three decades after its introduction.…”

Surgical treatment of bone metastases in patients with lung cancer

“…There is still a lack of data regarding the role of surgery in the management of bone metastasis although the prognosis of the patients could be improved by applying multimodal therapies [10][11][12]. Since treatment of bone metastases is palliative, it must be weighed up to complications in terminally ill patients.…”

Intérêt des lignanes dans la prévention et le traitement de cancers

“…L'étoposide est délivré en polythérapie en association avec d'autres produits anticancéreux et en particulier les dérivés du platine comme le cisplatine ou le carboplatine : il fait partie du traitement de référence de certains cancers comme ceux du poumon à petites cellules depuis les années 1980 [21,22]. Parmi les autres cancers traités par cette association, on peut citer également les tumeurs embryonnaires, les neuroblastomes, les cancers du rein, du sein, de la prostate, ainsi que les lymphomes hodgkiniens ou non hodgkiniens et les leucémies aiguës.…”

“…Parmi les autres cancers traités par cette association, on peut citer également les tumeurs embryonnaires, les neuroblastomes, les cancers du rein, du sein, de la prostate, ainsi que les lymphomes hodgkiniens ou non hodgkiniens et les leucémies aiguës. Bien que constituant une partie du traitement de référence, l'étopo-side et le téniposide ne sont pas sans inconvénients, dont certains sont communs à toutes les drogues cytotoxiques comme la toxicité hématologique, ou encore le développement de résistances [22]. De plus, probablement en raison de sa capacité à provoquer des dommages à l'ADN (en particulier des réarrangements dans le gène MLL) [23], l'étoposide peut aussi induire des leucémies secondaires, voire des leucémies infantiles suite à une exposition in utero, lorsque les doses cumulées totales dépassent 2 000 mg/m 2 [24] (les doses quotidiennes habituellement délivrées sont d'environ 100 mg/m 2 , par exemple en traitement de trois jours).…”