Update on small cell lung cancer management

Huber, Rudolf M.; Tufman, Amanda

doi:10.1183/20734735.013211

Cited by 14 publications

(8 citation statements)

References 79 publications

(83 reference statements)

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“…• 15-20% of new cases of lung cancer worldwide [21] • Median survival: 16-24 months (limited-stage disease), 6-12 months (extensive-stage) [22,23] • Most commonly prescribed first line: cisplatin + etoposide • NSCLC with EGFR mutations: EGFR inhibitors…”

Section: Cancer Site Epidemiologymentioning

confidence: 99%

A multidisciplinary expert opinion on CINV and RINV, unmet needs and practical real-life approaches

Bossi

Airoldi

Spiriti

et al. 2020

Expert Opinion on Drug Safety

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Introduction: A range of combination chemotherapy regimens are currently used in clinical practice. However, international antiemetic guidelines often only categorize the emetogenic potential of single agents rather than the emetogenicity of combination chemotherapy regimens. To manage the nausea and vomiting induced by antineoplastic combinations, guidelines suggest antiemetics that are appropriate for the component drug with the highest emetogenic potential. Furthermore, antiemetic guidelines generally do not consider the influence of other factors, including individual patient characteristics, on the emetic effects of cancer treatments. Similarly, the emetogenic potential of radiotherapy is stratified only according to the site of radiation, while other factors contributing to emetic risk are overlooked. Areas covered: An Expert Panel was convened to examine unresolved issues and summarize the current clinical research on managing nausea and vomiting associated with combination chemotherapy and radiotherapy. Expert opinion: The panel identified the incidence of nausea and vomiting induced by multi-drug combination therapies currently used to treat cancer at different anatomic sites and by radiotherapy in the presence of other risk factors. Based on these data and the clinical experience of panel members, several suggestions are made for a practical approach to prevent or manage nausea and vomiting due to chemotherapy regimens and radiation therapy.

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Section: Cancer Site Epidemiologymentioning

confidence: 99%

A multidisciplinary expert opinion on CINV and RINV, unmet needs and practical real-life approaches

Bossi

Airoldi

Spiriti

et al. 2020

Expert Opinion on Drug Safety

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“…Lung cancer is the leading cause of cancer-related deaths worldwide (1). Small-cell lung cancer (SCLC) accounts for 15% of lung cancer cases and has a high mortality rate due to rapid progression and metastases (2). Prophylactic cranial irradiation (PCI) offers SCLC patients with distant metastases (so-called "extensive disease" patients) a lower chance of developing brain metastasis, a slightly longer overall survival (OS) (median OS from 5.4 to 6.7 months;…”

Section: Introductionmentioning

confidence: 99%

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Ankolekar¹,

Ruysscher²,

Reymen³

et al. 2021

Transl Lung Cancer Res

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Background: Prophylactic cranial irradiation (PCI) offers extensive-stage small-cell lung cancer (ES-SCLC) patients a lower chance of brain metastasis and slightly longer survival but is associated with a short-term decline in quality of life due to side-effects. This tradeoff between survival and quality of life makes PCI suitable for shared decision-making (SDM), where patients and clinicians make treatment decisions together based on clinical evidence and patient preferences. Despite recent clinical practice guidelines recommending SDM for PCI in ES-SCLC, as well as the heavy disease burden, research into SDM for lung cancer has been scarce. This exploratory study presents patients' experiences of the SDM process and decisional conflict for PCI. Methods: Radiation oncologists (n=7) trained in SDM applied it in making the PCI decision with ES-SCLC patients (n=25). We measured patients' preferred level of participation (Control Preferences Scale), the level of SDM according to both groups (SDM-Q-9 and SDM-Q-Doc), and patients' decisional conflict [decisional conflict scale (DCS)].Results: Seventy-nine percent of patients preferred a collaborative role in decision-making, and median SDM scores given by patients and clinicians were 80 (IQR: 75.6-91.1) and 85.2 (IQR: 78.7-88.9) respectively, indicating satisfaction with the process. However, patients experienced considerable decisional conflict. Over 50% lacked clarity about which choice was suitable for them and were unsure what to choose. Sixty-four percent felt they did not know enough about the harms and benefits of PCI, and 60% felt unable to judge the importance of the harms/benefits in their life.Conclusions: ES-SCLC patients prefer to be involved in their treatment choice for PCI but a substantial portion experiences decisional conflict. Better information provision and values clarification may support patients in making a choice that reflects their preferences.

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“…Small cell lung cancer (SCLC) is a highly aggressive form of pulmonary malignancy which accounts for 15–20% of lung cancer cases [ 1 ]. SCLC is well known for its rapid doubling time, tendency to metastasize, and its affinity for relapsing.…”

Section: Introductionmentioning

confidence: 99%

“…SCLC is well known for its rapid doubling time, tendency to metastasize, and its affinity for relapsing. Nearly 60–70% of patients with SCLC present with disseminated disease [ 1 ], and early diagnosis improves outcomes. Typical presentations include cough, dyspnea, and weight loss.…”

Section: Introductionmentioning

confidence: 99%

Paraneoplastic syndrome as the presentation of limited stage small cell carcinoma

2018

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BackgroundSmall cell lung carcinoma (SCLC) is one of the deadliest forms of lung cancer due to its poor prognosis upon diagnosis, rapid doubling time, and affinity for metastasis. As 60–70% of patients with SCLC have disseminated disease upon presentation, it is imperative to determine the extent of disease burden for treatment. As a neuroendocrine carcinoma, clinicians must pay close attention to abnormal findings in a smoker that could lead to earlier diagnosis and better prognostication.Case presentationA 64 year-old 20-pack year smoker presented to the emergency department with nausea and vomiting for 3 days. No inciting events were elicited. History and review of symptoms were negative including symptoms most-commonly associated with malignancy such as fevers and weight loss. He also denied any pulmonary symptoms. Physical examination was benign except for right lung end-expiratory wheezing. Our patient was clinically euvolemic. Initial blood laboratories showed a sodium 110, serum osmolarity 227, and urine osmolarity of 579. Fluid restriction led to normalization of his sodium and resolution of nausea & vomiting. Chest radiography was obtained to follow-up on the wheezing, which was read as no acute cardiopulmonary disease by radiology. Due to high suspicion of SIADH from malignancy, a CT of the chest was performed which showed a conglomerate of nodules and opacities in the right upper lobe. Biopsy revealed SCLC. At outpatient follow-up, patient had a PET-CT showing one active mediastinal lymph node as the only site of metastasis. He received three round of chemotherapy, chest and prophylactic cranial radiation, and deemed in remission by oncology.Discussion and conclusionsDue to its affinity for metastases, 70% of patients with SCLC present with symptoms related to the spread of cancer to affected organ systems. Given the aggressive nature of this disease, screening measures have been implemented to help diagnose limited stage SCLC. Unfortunately, in our patient and many others, screening guidelines may fail to identify appropriate patients to scan. It is therefore imperative to use our clinical index of suspicion and identify any early presentations (including paraneoplastic syndromes) which may tip off the beginning stages of SCLC. This could improve survival rates by up to 45%.

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Update on small cell lung cancer management

Cited by 14 publications

References 79 publications

A multidisciplinary expert opinion on CINV and RINV, unmet needs and practical real-life approaches

A multidisciplinary expert opinion on CINV and RINV, unmet needs and practical real-life approaches

Shared decision-making for prophylactic cranial irradiation in extensive-stage small-cell lung cancer: an exploratory study

Paraneoplastic syndrome as the presentation of limited stage small cell carcinoma

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