Small cell carcinoma of the lung medical therapy
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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 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.
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 (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
| 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 until 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:
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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.