Small cell carcinoma of the lung medical therapy: Difference between revisions

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Latest revision as of 23:34, 4 September 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Patients with small cell carcinoma of the lung (SCCL) have many treatment options.The selection of management depends on the stage of the tumor, limited stage versus extensive stage. The options are radiation therapy, chemotherapy, surgery, or a combination of these methods. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next. SCCL patients are encouraged to participate in clinical trials that investigate new regimens. In addition, SCCL patients should be strongly encouraged to discontinue smoking.

Medical Therapy

Limited Stage SCCL

The algorithm is based on the National Comprehensive Cancer Network (NCCN) guidelines.^[1]

Limited stage SCC

Clinical stage T(1-2),N(0)

Limited stage in excess of T(1-2),N(0)

What are the statuses of the pathologic mediastinal staging AND operability of the patient?

What is the performance status of the patient?

Negative pathologic mediastinal staging
AND
Patient is medically operable

Positive pathologic mediastinal staging
OR
Patient is medically operable

Good (PS 0-2)

Poor (PS 3-4) due to SCC

Poor (PS 3-4) not due to SCC

Lobectomy
PLUS
Lymph node dissection or sampling

What is the performance status of the patient?

Chemotherapy
PLUS
Thoracic radiation therapy (concurrently)

Chemotherapy
WITH/WITHOUT
Thoracic radiation therapy (concurrently)

Individualized treatment
PLUS
Supportive treatment

What is the status of involvement of the lymph nodes?

Good (PS 0-2)

Poor (PS 3-4) due to SCC

Poor (PS 3-4) not due to SCC

N0

N+

Chemotherapy
PLUS
Thoracic radiation therapy (concurrently)

Chemotherapy
WITH/WITHOUT
Thoracic radiation therapy (concurrently)

Individualized treatment
PLUS
Supportive treatment

Chemotherapy

Chemotherapy
PLUS
Mediastinal radiation therapy (concurrently)

Extensive Stage

The algorithm is based on the National Comprehensive Cancer Network (NCCN) guidelines.^[1]

Extensive stage

Is there symptomatic localized metastasis
OR
brain metastasis?

No

Yes, there is symptomatic localized metastasis

Yes, there is brain metastasis

What is the performance status of the patient?

What metastasis related symptoms does the patient have?

Is the patient symptomatic?

Good (PS 0-2)
OR
Poor (3-4) due to SCLC

Poor (3-4) not due to SCLC

Superior vena cava syndrome
OR
Lobar obstruction
OR
Bone metastasis

Spinal cord compression

Yes

No

Combination Chemotherapy
PLUS
Supportive treatment

Individualized therapy
PLUS
Supportive treatment

Chemotherapy
WITH/WITHOUT
radiation therapy to the sites of metastasis

radiation therapy to the sites of metastasis
THEN
Chemotherapy (unless medical therapy is immediately necessary)

Whole brain radiation therapy
THEN
Chemotherapy (unless medical therapy is immediately necessary)

Chemotherapy
THEN
Whole brain radiation therapy

Is the patient at elevated risk for fracture?

Yes

No

Palliative external beam radiation therapy
PLUS
Orthopedic stabilization

No additional measures

Choices for Initial or Adjuvant Chemotherapy

Shown below is a table depicting the different choices of regimens for the initial or adjuvant chemotherapy of patients with small cell carcinoma of the lung. The list of regimens has been adapted from the National Comprehensive Cancer Network (NCCN) guidelines.^[1]

Choices for initial or adjuvant chemotherapy (maximum number of cycles: 4-6)
Limited stage SCLC
Cisplatin 60 mg/m² (day 1) PLUS Etoposide 120 mg/m² (day 1, 2, 3)^[2]
Cisplatin 80 mg/m² (day 1) PLUS Etoposide 100 mg/m² (day 1, 2, 3)^[3]
Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m² (day 1, 2, 3)^[4]
Extensive stage SCLC
Cisplatin 75 mg/m² (day 1) PLUS Etoposide 100 mg/m² (day 1, 2, 3)^[5]
Cisplatin 80 mg/m² (day 1) PLUS Etoposide 80 mg/m² (day 1, 2, 3)^[6]
Cisplatin 25 mg/m² (day 1, 2, 3) PLUS Etoposide 100 mg/m² (day 1, 2, 3)^[7]
Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m² (day 1, 2, 3)^[8]
Cisplatin 60 mg/m² (day 1) PLUS Irinotecan 60 mg/m² (day 1, 8, 15)^[9]
Cisplatin 30 mg/m² (day 1) PLUS Irinotecan 65 mg/m² (day 1, 8, 21)^[10]
Carboplatin AUC 5 (day 1) PLUS Irinotecan 50 mg/m² (day 1, 8, 15)^[11]

Therapy for Relapse or Progressive Disease

Therapy for relapse of progressive disease

What is the performance status of the patient?

Good (PS 0-2)

Poor (PS 3-4)

Chemotherapy
OR
Palliative therapy

Palliative therapy

Choices for Chemotherapy for Relapse or Progressive Disease

Among patients receiving chemotherapy for relapse, the involvement in clinical trials is encouraged.^[1]

The chemotherapy for relapse or progressive disease should be administered for two cycles following the optimal response, or until the occurrence of treatment-related toxicity.^[1]

The suggested choices for chemotherapy depend on the duration of time that elapsed between the completion of the initial regimen and the relapse.
- If the relapse occurred less than 2-3 months following the initial treatment and the performance status is good (PS 0-2), the choices for chemotherapy include: docetaxel, gemcitabine, ifosfamide, irinotecan, paclitaxel, temozolomide, and topotecan.^[1]
- If the relapse occurred more than 2-3 months but not later than 6 months following the initial treatment, the choices for chemotherapy include: Combination of cyclophosphamide and doxorubicin and vincristine, docetaxel, etoposide, gemcitabine, ifosfamide, irinotecan, paclitaxel, temozolomide, topotecan, and vinorelbine.^[1]
- If the relapse occurred more than 6 months following the initial treatment, the initial chemotherapy regimen should be repeated.^[1]

Supportive Treatment

Supportive treatment for patients with SCCL should include the following:^[1]

Pain management
Management of nausea and vomiting
Psychosocial support
Counseling for smoking cessation
Treatment of complications:
- Syndrome of insufficient antidiuretic hormone
- Cushing's disease

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 ^1.8 NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014
↑ Turrisi AT, Kim K, Blum R, Sause WT, Livingston RB, Komaki R; et al. (1999). "[[Small cell carcinoma of the lung radiation therapy|radiation therapy]]". N Engl J Med. 340 (4): 265–71. doi:10.1056/NEJM199901283400403. PMID 9920950. URL–wikilink conflict (help)
↑ Saito H, Takada Y, Ichinose Y, Eguchi K, Kudoh S, Matsui K; et al. (2006). "[[Small cell carcinoma of the lung radiation therapy|radiation therapy]]". J Clin Oncol. 24 (33): 5247–52. doi:10.1200/JCO.2006.07.1605. PMID 17114657. URL–wikilink conflict (help)
↑ Skarlos DV, Samantas E, Briassoulis E, Panoussaki E, Pavlidis N, Kalofonos HP; et al. (2001). "Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG)". Ann Oncol. 12 (9): 1231–8. PMID 11697833.
↑ Sundstrøm S, Bremnes RM, Kaasa S, Aasebø U, Hatlevoll R, Dahle R; et al. (2002). "Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up". J Clin Oncol. 20 (24): 4665–72. PMID 12488411.
↑ Ihde DC, Mulshine JL, Kramer BS, Steinberg SM, Linnoila RI, Gazdar AF; et al. (1994). "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. PMID 7931470.
↑ Evans WK, Shepherd FA, Feld R, Osoba D, Dang P, Deboer G (1985). "VP-16 and cisplatin as first-line therapy for small-cell lung cancer". J Clin Oncol. 3 (11): 1471–7. PMID 2997406.
↑ Okamoto H, Watanabe K, Nishiwaki Y, Mori K, Kurita Y, Hayashi I; et al. (1999). "Phase II study of area under the plasma-concentration-versus-time curve-based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer". J Clin Oncol. 17 (11): 3540–5. PMID 10550152.
↑ Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A; et al. (2002). "Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer". N Engl J Med. 346 (2): 85–91. doi:10.1056/NEJMoa003034. PMID 11784874.
↑ Hanna N, Bunn PA, Langer C, Einhorn L, Guthrie T, Beck T; et al. (2006). "Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer". J Clin Oncol. 24 (13): 2038–43. doi:10.1200/JCO.2005.04.8595. PMID 16648503.
↑ Schmittel A, Fischer von Weikersthal L, Sebastian M, Martus P, Schulze K, Hortig P; et al. (2006). "A randomized phase II trial of irinotecan plus carboplatin versus etoposide plus carboplatin treatment in patients with extended disease small-cell lung cancer". Ann Oncol. 17 (4): 663–7. doi:10.1093/annonc/mdj137. PMID 16423848.

Template:WikiDoc Sources

[NCCN-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 ^1.7 ^1.8 NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014

[pmid9920950-2] Turrisi AT, Kim K, Blum R, Sause WT, Livingston RB, Komaki R; et al. (1999). "[[Small cell carcinoma of the lung radiation therapy|radiation therapy]]". N Engl J Med. 340 (4): 265–71. doi:10.1056/NEJM199901283400403. PMID 9920950. URL–wikilink conflict (help)

[pmid17114657-3] Saito H, Takada Y, Ichinose Y, Eguchi K, Kudoh S, Matsui K; et al. (2006). "[[Small cell carcinoma of the lung radiation therapy|radiation therapy]]". J Clin Oncol. 24 (33): 5247–52. doi:10.1200/JCO.2006.07.1605. PMID 17114657. URL–wikilink conflict (help)

[pmid11697833-4] Skarlos DV, Samantas E, Briassoulis E, Panoussaki E, Pavlidis N, Kalofonos HP; et al. (2001). "Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG)". Ann Oncol. 12 (9): 1231–8. PMID 11697833.

[pmid12488411-5] Sundstrøm S, Bremnes RM, Kaasa S, Aasebø U, Hatlevoll R, Dahle R; et al. (2002). "Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up". J Clin Oncol. 20 (24): 4665–72. PMID 12488411.

[pmid7931470-6] Ihde DC, Mulshine JL, Kramer BS, Steinberg SM, Linnoila RI, Gazdar AF; et al. (1994). "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. PMID 7931470.

[pmid2997406-7] Evans WK, Shepherd FA, Feld R, Osoba D, Dang P, Deboer G (1985). "VP-16 and cisplatin as first-line therapy for small-cell lung cancer". J Clin Oncol. 3 (11): 1471–7. PMID 2997406.

[pmid10550152-8] Okamoto H, Watanabe K, Nishiwaki Y, Mori K, Kurita Y, Hayashi I; et al. (1999). "Phase II study of area under the plasma-concentration-versus-time curve-based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer". J Clin Oncol. 17 (11): 3540–5. PMID 10550152.

[pmid11784874-9] Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A; et al. (2002). "Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer". N Engl J Med. 346 (2): 85–91. doi:10.1056/NEJMoa003034. PMID 11784874.

[pmid16648503-10] Hanna N, Bunn PA, Langer C, Einhorn L, Guthrie T, Beck T; et al. (2006). "Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer". J Clin Oncol. 24 (13): 2038–43. doi:10.1200/JCO.2005.04.8595. PMID 16648503.

[pmid16423848-11] Schmittel A, Fischer von Weikersthal L, Sebastian M, Martus P, Schulze K, Hortig P; et al. (2006). "A randomized phase II trial of irinotecan plus carboplatin versus etoposide plus carboplatin treatment in patients with extended disease small-cell lung cancer". Ann Oncol. 17 (4): 663–7. doi:10.1093/annonc/mdj137. PMID 16423848.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Small cell carcinoma of the lung}}
-{{CMG}}
+{{CMG}}; {{AE}} {{Rim}}
 ==Overview==
-Patients with small cell carcinoma (SCC) of the lung have many treatment options. The selection depends on the stage of the tumor. The options are radiation therapy, chemotherapy, surgery, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
+Patients with small cell carcinoma of the lung (SCCL) have many treatment options.The selection of management depends on the stage of the [[tumor]], limited stage versus extensive stage. The options are [[Small cell carcinoma of the lung radiation therapy|radiation therapy]], [[chemotherapy]], [[Small cell carcinoma of the lung surgery|surgery]], or a combination of these methods. Because [[cancer]] treatments often damage healthy [[Cells (biology)|cells]] and [[tissues]], [[side effects]] are common. [[Side effects]] may not be the same for each person, and they may change from one treatment session to the next. SCCL patients are encouraged to participate in [[clinical trial]]s that investigate new regimens. In addition, SCCL patients should be strongly encouraged to discontinue [[smoking]].
+==Medical Therapy==
+===Limited Stage SCCL===
+The algorithm is based on the National Comprehensive Cancer Network (NCCN) guidelines.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
-==Initial Medical Therapy==
-===Limited Stage SCC===
 {{Family tree/start}}
 {{familytree | | | | | | | | | | | | | A01 | | | | | | A01= '''Limited stage SCC'''}}
@@ Line 13: / Line 15: @@
 {{familytree | | | | | | | B01 | | | | | | | | | | B02 | B01= '''Clinical stage T(1-2),N(0)'''| B02= '''Limited stage in excess of T(1-2),N(0)'''}}
 {{familytree | | | | | | | |!| | | | | | | | | | | |!| }}
-{{familytree | | | | | | | C01 | | | | | | | | | | C02 | | | | | C01= What is the statuses of the pathologic mediastinal staging AND operability of the patient?| C02= What is the performance status of the patient?}}
+{{familytree | | | | | | | C01 | | | | | | | | | | C02 | | | | | C01= What are the statuses of the pathologic mediastinal staging AND operability of the patient?| C02= What is the [[performance status]] of the patient?}}
 {{familytree | | | |,|-|-|-|^|-|-|-|.| | | |,|-|-|-|+|-|-|-|.| | }}
 {{familytree | | | D01 | | | | | | D02 | | D03 | | D04 | | D05 | D01= Negative pathologic mediastinal staging<br> AND <br> Patient is medically operable| D02= Positive pathologic mediastinal staging<br> OR <br> Patient is medically operable| D03= Good (PS 0-2)| D04= Poor (PS 3-4) due to SCC| D05= Poor (PS 3-4) not due to SCC}}
 {{familytree | | | |!| | | | | | | |!| | | |!| | | |!| | | | | | }}
-{{familytree | | | E01 | | | | | | E02 | | E03 | | E04 | | E05 | E01= Lobectomy <br> PLUS <br> Lymph node dissection or sampling| E02= What is the performance status of the patient?| E03= Chemotherapy <br> PLUS <br> Thoracic radiation therapy| E04= Chemotherapy <br> WITH/WITHOUT <br> Thoracic radiation therapy| E05= Individualized treatment <br> PLUS <br>supportive care}}
+{{familytree | | | E01 | | | | | | E02 | | E03 | | E04 | | E05 | E01= [[Lobectomy]] <br> PLUS <br> [[Lymph node]] dissection or sampling| E02= What is the [[performance status]] of the patient?| E03= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> PLUS <br> Thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] (concurrently)| E04= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> WITH/WITHOUT <br> Thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] (concurrently)| E05= Individualized treatment <br> PLUS <br>[[Small cell carcinoma of the lung medical therapy#Supportive treatment|Supportive treatment]]}}
 {{familytree | | | |!| | | | | |,|-|^|-|v|-|-|-|.| | | }}
 {{familytree | | | F01 | | | | F03 | | F04 | | F05 | | F01= What is the status of involvement of the lymph nodes?| F03= Good (PS 0-2)| F04= Poor (PS 3-4) due to SCC| F05= Poor (PS 3-4) not due to SCC}}
 {{familytree | |,|-|^|-|.| | | |!| | | |!| | | |!| |}}
-{{familytree | G01 | | G02 | | G03 | | G04 | | G05 | | |  G01= N0| G02= N+| G03= Chemotherapy <br> PLUS <br> Thoracic radiation therapy| G04= Chemotherapy <br> WITH/WITHOUT <br> Thoracic radiation therapy| G05= Individualized treatment <br> PLUS <br>supportive care}}
+{{familytree | G01 | | G02 | | G03 | | G04 | | G05 | | |  G01= N0| G02= N+| G03= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> PLUS <br> Thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] (concurrently)| G04= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> WITH/WITHOUT <br> Thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] (concurrently)| G05= Individualized treatment <br> PLUS <br>[[Small cell carcinoma of the lung medical therapy#Supportive treatment|Supportive treatment]]}}
 {{familytree | |!| | | |!| | | | }}
-{{familytree | H01 | | H02 | | | H01= Chemotherapy| H02= Chemotherapy <br> PLUS <br>Mediastinal radiotherapy}}
+{{familytree | H01 | | H02 | | | H01= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]]| H02= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> PLUS <br>Mediastinal [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] (concurrently)}}
 {{familytree/end}}
 ===Extensive Stage===
+The algorithm is based on the National Comprehensive Cancer Network (NCCN) guidelines.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
 {{Family tree/start}}
-{{familytree | | | | | | | | | | | A01 | | | | | | | | | | }}
+{{familytree | | | | | | | | | | | A01 | | | | | | | | | | A01= '''Extensive stage'''}}
 {{familytree | | | | | | | | | | | |!| | | | | | | | | | | }}
-{{familytree | | | | | | | | | | | B01 | | | | | | | | | | }}
+{{familytree | | | | | | | | | | | B01 | | | | | | | | | | B01= '''Is there symptomatic localized metastasis''' <br> '''OR''' <br> '''brain metastasis?'''}}
 {{familytree | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | | }}
-{{familytree | | | C01 | | | | | | C02 | | | | | | C03 | | }}
+{{familytree | | | C01 | | | | | | C02 | | | | | | C03 | | C01= '''No'''| C02= '''Yes, there is symptomatic localized metastasis'''| C03= '''Yes, there is brain metastasis'''}}
 {{familytree | | | |!| | | | | | | |!| | | | | | | |!| | | }}
-{{familytree | | | D01 | | | | | | D02 | | | | | | D03 | | }}
+{{familytree | | | D01 | | | | | | D02 | | | | | | D03 | | D01= What is the [[performance status]] of the patient?| D02= What [[metastasis]] related symptoms does the patient have?| D03= Is the patient symptomatic?}}
 {{familytree | |,|-|^|-|.| | | |,|-|^|-|.| | | |,|-|^|-|.| }}
-{{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | }}
+{{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | E01= Good (PS 0-2) <br> OR <br> Poor (3-4) due to SCLC| E02= Poor (3-4) not due to SCLC| E03= [[Superior vena cava syndrome]] <br> OR <br> [[Lobar obstruction]] <br>OR <br> [[Bone metastasis]]| E04= [[Spinal cord compression]]| E05= Yes|E06= No}}
 {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }}
-{{familytree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | }}
+{{familytree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | F01= Combination [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> PLUS <br> [[Small cell carcinoma of the lung medical therapy#Supportive treatment|Supportive treatment]]| F02= Individualized therapy <br> PLUS <br> [[Small cell carcinoma of the lung medical therapy#Supportive treatment|Supportive treatment]]| F03= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br>WITH/WITHOUT <br> [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] to the sites of metastasis| F04= [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] to the sites of metastasis<br> THEN <br> [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] (unless medical therapy is immediately necessary)| F05= Whole brain [[Small cell carcinoma of the lung radiation therapy|radiation therapy]]<br> THEN <br> [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] (unless medical therapy is immediately necessary)|F06= [[Small cell carcinoma of the lung medical therapy#Choices for Initial or Adjuvant Chemotherapy|Chemotherapy]] <br> THEN <br> Whole brain [[Small cell carcinoma of the lung radiation therapy|radiation therapy]]}}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | G01 | | | | | | | | | | | | | }}
+{{familytree | | | | | | | | | G01 | | | | | | | | | | | | | G01= Is the patient at elevated risk for fracture?}}
 {{familytree | | | | | | | |,|-|^|-|.| | | | | | | | | | | }}
-{{familytree | | | | | | | H01 | | H02 | | | | | | | | | | }}
+{{familytree | | | | | | | H01 | | H02 | | | | | | | | | | H01= Yes| H02= No}}
 {{familytree | | | | | | | |!| | | |!| | | | | | | | | | | }}
-{{familytree | | | | | | | I01 | | I02 | | | | | | | | | | }}
+{{familytree | | | | | | | I01 | | I02 | | | | | | | | | | I01= Palliative external beam [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] <br> PLUS <br> Orthopedic stabilization| I02= No additional measures}}
 {{Family tree/end}}
-==Adjuvant Medical Therapy==
+==Choices for Initial or Adjuvant Chemotherapy==
+Shown below is a table depicting the different choices of regimens for the initial or [[adjuvant chemotherapy]] of patients with small cell carcinoma of the [[lung]]. The list  of regimens has been adapted from the National Comprehensive Cancer Network (NCCN) guidelines.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
-==Therapy for Relapse or Palliative Therapy==
+{| style="cellpadding=0; cellspacing= 0; width: 600px;"
+|-
+| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 70%" align="center" |'''Choices for initial or adjuvant chemotherapy (maximum number of cycles: 4-6)'''
+|-
+| colspan="2" style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align="left" |'''''Limited stage SCLC'''''
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 60 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Etoposide]] 120 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid9920950">{{cite journal| author=Turrisi AT, Kim K, Blum R, Sause WT, Livingston RB, Komaki R et al.| title=Twice-daily compared with once-daily thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] in limited small-cell lung cancer treated concurrently with cisplatin and etoposide. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 4 | pages= 265-71 | pmid=9920950 | doi=10.1056/NEJM199901283400403 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9920950  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 80 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Etoposide]] 100 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid17114657">{{cite journal| author=Saito H, Takada Y, Ichinose Y, Eguchi K, Kudoh S, Matsui K et al.| title=Phase II study of etoposide and cisplatin with concurrent twice-daily thoracic [[Small cell carcinoma of the lung radiation therapy|radiation therapy]] followed by irinotecan and cisplatin in patients with limited-disease small-cell lung cancer: West Japan Thoracic Oncology Group 9902. | journal=J Clin Oncol | year= 2006 | volume= 24 | issue= 33 | pages= 5247-52 | pmid=17114657 | doi=10.1200/JCO.2006.07.1605 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17114657  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Carboplatin]] AUC 5-6 (day 1) <br> PLUS <br> [[Etoposide]] 100 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid11697833">{{cite journal| author=Skarlos DV, Samantas E, Briassoulis E, Panoussaki E, Pavlidis N, Kalofonos HP et al.| title=Randomized comparison of early versus late hyperfractionated thoracic irradiation concurrently with chemotherapy in limited disease small-cell lung cancer: a randomized phase II study of the Hellenic Cooperative Oncology Group (HeCOG). | journal=Ann Oncol | year= 2001 | volume= 12 | issue= 9 | pages= 1231-8 | pmid=11697833 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11697833  }} </ref>
+|-
+| colspan="2" style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align="left" |'''''Extensive stage SCLC'''''
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 75 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Etoposide]] 100 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid12488411">{{cite journal| author=Sundstrøm S, Bremnes RM, Kaasa S, Aasebø U, Hatlevoll R, Dahle R et al.| title=Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up. | journal=J Clin Oncol | year= 2002 | volume= 20 | issue= 24 | pages= 4665-72 | pmid=12488411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12488411  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 80 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Etoposide]] 80 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid7931470">{{cite journal| author=Ihde DC, Mulshine JL, Kramer BS, Steinberg SM, Linnoila RI, Gazdar AF et al.| title=Prospective randomized comparison of high-dose and standard-dose etoposide and cisplatin chemotherapy in patients with extensive-stage small-cell lung cancer. | journal=J Clin Oncol | year= 1994 | volume= 12 | issue= 10 | pages= 2022-34 | pmid=7931470 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7931470  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 25 mg/m<sup>2</sup> (day 1, 2, 3) <br> PLUS <br> [[Etoposide]] 100 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid2997406">{{cite journal| author=Evans WK, Shepherd FA, Feld R, Osoba D, Dang P, Deboer G| title=VP-16 and cisplatin as first-line therapy for small-cell lung cancer. | journal=J Clin Oncol | year= 1985 | volume= 3 | issue= 11 | pages= 1471-7 | pmid=2997406 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2997406  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Carboplatin]] AUC 5-6 (day 1) <br> PLUS <br> [[Etoposide]] 100 mg/m<sup>2</sup> (day 1, 2, 3)<ref name="pmid10550152">{{cite journal| author=Okamoto H, Watanabe K, Nishiwaki Y, Mori K, Kurita Y, Hayashi I et al.| title=Phase II study of area under the plasma-concentration-versus-time curve-based carboplatin plus standard-dose intravenous etoposide in elderly patients with small-cell lung cancer. | journal=J Clin Oncol | year= 1999 | volume= 17 | issue= 11 | pages= 3540-5 | pmid=10550152 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10550152  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 60 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Irinotecan]] 60 mg/m<sup>2</sup> (day 1, 8, 15)<ref name="pmid11784874">{{cite journal| author=Noda K, Nishiwaki Y, Kawahara M, Negoro S, Sugiura T, Yokoyama A et al.| title=Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. | journal=N Engl J Med | year= 2002 | volume= 346 | issue= 2 | pages= 85-91 | pmid=11784874 | doi=10.1056/NEJMoa003034 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11784874  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Cisplatin]] 30 mg/m<sup>2</sup> (day 1) <br> PLUS <br> [[Irinotecan]] 65 mg/m<sup>2</sup> (day 1, 8, 21)<ref name="pmid16648503">{{cite journal| author=Hanna N, Bunn PA, Langer C, Einhorn L, Guthrie T, Beck T et al.| title=Randomized phase III trial comparing irinotecan/cisplatin with etoposide/cisplatin in patients with previously untreated extensive-stage disease small-cell lung cancer. | journal=J Clin Oncol | year= 2006 | volume= 24 | issue= 13 | pages= 2038-43 | pmid=16648503 | doi=10.1200/JCO.2005.04.8595 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16648503  }} </ref>
+|-
+| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |[[Carboplatin]] AUC 5 (day 1) <br> PLUS <br> [[Irinotecan]] 50 mg/m<sup>2</sup> (day 1, 8, 15)<ref name="pmid16423848">{{cite journal| author=Schmittel A, Fischer von Weikersthal L, Sebastian M, Martus P, Schulze K, Hortig P et al.| title=A randomized phase II trial of irinotecan plus carboplatin versus etoposide plus carboplatin treatment in patients with extended disease small-cell lung cancer. | journal=Ann Oncol | year= 2006 | volume= 17 | issue= 4 | pages= 663-7 | pmid=16423848 | doi=10.1093/annonc/mdj137 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16423848  }} </ref>
+|}
+==Therapy for Relapse or Progressive Disease==
+{{Family tree/start}}
+{{familytree | | | A01 | | | | | A01= '''Therapy for relapse of progressive disease'''}}
+{{familytree | | | |!| | | | | | }}
+{{familytree | | | B01 | | | | | B01= '''What is the [[performance status]] of the patient?'''}}
+{{familytree | |,|-|^|-|.| | | | }}
+{{familytree | C01 | | C02 | | | C01= Good (PS 0-2)| C02= Poor (PS 3-4)}}
+{{familytree | |!| | | |!| | | | }}
+{{familytree | D01 | | D02 | | | D01= Chemotherapy <br> OR <br> Palliative therapy| D02= Palliative therapy}}
+{{Family tree/end}}
+===Choices for Chemotherapy for Relapse or Progressive Disease===
+* Among patients receiving [[chemotherapy]] for relapse, the involvement in clinical trials is encouraged.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+* The [[chemotherapy]] for [[relapse]] or progressive disease should be administered for two cycles following the optimal response, or until the occurrence of treatment-related [[toxicity]].<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+* The suggested choices for [[chemotherapy]] depend on the duration of time that elapsed between the completion of the initial regimen and the relapse.
+** If the relapse occurred less than 2-3 months following the initial treatment and the [[performance status]] is good (PS 0-2), the choices for chemotherapy include: [[docetaxel]], [[gemcitabine]], [[ifosfamide]], [[irinotecan]], [[paclitaxel]], [[temozolomide]], and [[topotecan]].<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+** If the relapse occurred more than 2-3 months but not later than 6 months following the initial treatment, the choices for [[chemotherapy]] include: Combination of [[cyclophosphamide]] and [[doxorubicin]] and [[vincristine]], [[docetaxel]], [[etoposide]], [[gemcitabine]], [[ifosfamide]], [[irinotecan]], [[paclitaxel]], [[temozolomide]], [[topotecan]], and [[vinorelbine]].<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+** If the [[relapse]] occurred more than 6 months following the initial treatment, the initial [[chemotherapy]] regimen should be repeated.<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+==Supportive Treatment==
+Supportive treatment for patients with SCCL should include the following:<ref name="NCCN">[http://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer, version 2.2014] </ref>
+* [[Pain]] management
+* Management of [[nausea]] and [[vomiting]]
+* Psychosocial support
+* Counseling for [[smoking cessation]]
+* Treatment of complications:
+** [[Syndrome of inappropriate antidiuretic hormone medical therapy|Syndrome of insufficient antidiuretic hormone]]
+** [[Cushing's syndrome medical therapy|Cushing's disease]]
 ==References==
 {{Reflist|2}}
-[[Category:Needs content]]
 [[Category:Disease]]
-[[Category:Endocrinology]]
+[[Category:Types of cancer]]
 [[Category:Pulmonology]]
-[[Category:Oncology]]
+[[Category:Lung cancer]]
 [[Category:Mature chapter]]
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 {{WikiDoc Sources}}
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Pulmonology]]
+[[Category:Surgery]]

Small cell carcinoma of the lung medical therapy: Difference between revisions

Latest revision as of 23:34, 4 September 2019

Overview

Medical Therapy

Limited Stage SCCL

Extensive Stage

Choices for Initial or Adjuvant Chemotherapy

Therapy for Relapse or Progressive Disease

Choices for Chemotherapy for Relapse or Progressive Disease

Supportive Treatment

References

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