Recent advances in management of small-cell lung cancer.
Small-cell lung cancer (SCLC) is a smoking-related disease with a poor prognosis. While SCLC is usually initially sensitive to chemotherapy and radiotherapy, responses are rarely long lasting. Frustratingly, most patients ultimately relapse, often with increasingly treatment resistant disease. Many strategies have been developed in an attempt to improve treatment outcomes, which have plateaued since the introduction of combination chemotherapy in the 1980s. These include trials of maintenance therapy, and dose intensification, the latter by means of increasing dose density, growth factor support and high dose chemotherapy with autologous stem cell rescue. None have been shown to improve patient survival. On the other hand, the integration of concurrent thoracic radiation and prophylactic cranial irradiation has improved the survival outcomes in patients with limited disease. In extensive disease, irinotecan combined with cisplatin has shown promise in improving survival over conventional platinum/etoposide chemotherapy schedules and a confirmatory study is awaited. The future of SCLC treatment may however lie with molecularly targeted therapies, such as antiangiogenesis agents and signal transduction inhibitors, which are being studied at present.
Medical Oncology Unit, The Canberra Hospital, P.O. Box 11, Woden, ACT 2606, Australia.
Yu Jo
YJ
Chua
Christopher
C
Steer
Desmond
D
Yip
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001549:Benzamides; D001932:Brain Neoplasms / Q000517:prevention & control / Q000556:secondary; D019496:Cancer Vaccines / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D019583:Dose Fractionation, Radiation; D004334:Drug Administration Schedule; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D015316:Genetic Therapy; D006133:Growth Substances / Q000008:administration & dosage; D006801:Humans; D000068877:Imatinib Mesylate; D007372:Interferons / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000628:therapy*; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors; D012907:Smoking / Q000009:adverse effects; D033581:Stem Cell Transplantation; D013792:Thalidomide / Q000627:therapeutic use; D014182:Transplantation, Autologous
D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D001549:Benzamides; D019496:Cancer Vaccines; D066246:ErbB Receptors; D006133:Growth Substances; D000068877:Imatinib Mesylate; D007372:Interferons; D010879:Piperazines; D011743:Pyrimidines; D018719:Erb-b2 Receptor Tyrosine Kinases; D013792:Thalidomide