Systemic Therapy for Small Cell Lung Cancer (SCLC)
Source: Shutterstock
Dealing with small cell lung cancer (SCLC) can be incredibly overwhelming. This type of lung cancer tends to grow aggressively and rapidly. It also spreads early, making it difficult to catch in its early “limited”stage. Although around two-thirds of SCLC cases are diagnosed at the extensive stage, there are treatment options available. The primary focus of these treatment strategies is systemic therapy, which includes chemotherapy. For SCLC, the National Comprehensive Cancer Network (NCCN) recommends treatment options based on two cancer stages:
Limited stage (stages 1-3)
- Treated to cure
- Employ local treatments like surgery and radiation therapy
- Followed by systemic therapy (as adjuvant therapy)
- Prophylactic cranial irradiation (PCI)
Extensive stage (stage 4)
- To control symptoms and prolong life
- Treated mainly by systemic therapy
- Can’t be treated with high radiation doses
- Radiation therapy may be used as palliative care (to reduce symptoms)
Treatment regimen for limited-stage SCLC
Chemotherapeutic drugs used:
- Platinum drugs (cisplatin or carboplatin) plus etoposide
- May be combined with radiation therapy (chemoradiation)
Older or frail patients with a poor (higher) performance score may not tolerate chemoradiation. These patients will get personalized treatment, including palliative care.
First-line treatment for limited-stage SCLC
Stage 1A, 1B and 2A | Stage 2B, 3A, 3B and 3C |
|---|---|
| Performance Score 0-2
Performance Score 3 and 4 caused by SCLC
|
Treatment regimen for extensive-stage SCLC
If the response from chemoimmunotherapy is good and stable, patients may drop other drugs and stay with the checkpoint inhibitor. This is called maintenance therapy. Often, patients receive maintenance immunotherapy to prolong disease stability and delay cancer progression for as long as possible.
Some people cannot tolerate immunotherapy, so it is not an option for them. Doctors will recommend alternative treatments for them.
Palliative radiation therapy is given to reduce pain due to SCLC metastasis in other organs, such as bone, spinal cord and brain.
Chemotherapeutic drugs | *Immune checkpoint inhibitor (added in case of chemoimmunotherapy) | |
|---|---|---|
Preferred regimens |
|
|
Other regimens |
| |
Prescribed sometimes |
|
|
*After chemoimmunotherapy, checkpoint inhibitor will be continued as maintenance therapy.
Taken from NCCN Guidelines for Patients: Small Cell Lung Cancer
Brand names for drugs mentioned
- Platinol® (cisplatin)
- Paraplatin® (carboplatin)
- VePesid® or Etopophos® (etoposide)
- Tecentriq® (atezolizumab)
- Imfinzi® (durvalumab)
- Camptosar® (irinotecan)
This treatment journey can be challenging, but patients can trust their healthcare team to provide the most effective treatments which will be personalized for each patient.
Related: Immunotherapy for Lung Cancer
