Small cell carcinoma of the lung medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

Initial Medical Therapy

Limited Stage SCC

Limited stage SCC

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

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

What is 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

Chemotherapy WITH/WITHOUT Thoracic radiation therapy

Individualized treatment PLUS supportive care

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

Chemotherapy WITH/WITHOUT Thoracic radiation therapy

Individualized treatment PLUS supportive care

Chemotherapy

Chemotherapy PLUS Mediastinal radiotherapy

Extensive Stage

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 care

Individualized therapy PLUS Supportive care

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

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)

Cisplatin 80 mg/m2 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3)

Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3)

Extensive stage SCLC

Cisplatin 75 mg/m2 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3)

Cisplatin 80 mg/m2 (day 1) PLUS Etoposide 80 mg/m2 (day 1, 2, 3)

Cisplatin 25 mg/m2 (day 1, 2, 3) PLUS Etoposide 100 mg/m2 (day 1, 2, 3)

Carboplatin AUC 5-6 (day 1) PLUS Etoposide 100 mg/m2 (day 1, 2, 3)

Cisplatin 60 mg/m2 (day 1) PLUS Irinotecan 60 mg/m2 (day 1, 8, 15)

Cisplatin 30 mg/m2 (day 1) PLUS Irinotecan 65 mg/m2 (day 1, 8, 21)

Carboplatin AUC 5 (day 1) PLUS Irinotecan 50 mg/m2 (day 1, 8, 15)

References

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