Overview

When lung cancer has been detected or has returned following an initial treatment with surgery, radiation and/or chemotherapy, it is referred to as recurrent or relapsed.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of recurrent small cell lung cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Chemotherapy

Chemotherapy for relapsed SCLC often involves a single drug, and several different options are available. The likely response to second-line chemotherapy depends in part on how quickly a patient relapses after initial treatment. Patients who relapse soon after initial treatment (within three months) tend to have low rates of response to subsequent treatment. Response rates are higher for people who relapse more than three months after initial treatment.

Radiation Therapy

For people with certain types of metastatic cancer (cancer that has spread to other parts of the body), radiation therapy may provide relief from symptoms. Cancer that has spread to the brain, for example, is often treated with radiation therapy.

Strategies to Improve Treatment

While progress has been made in the treatment of small cell lung cancer, better treatment strategies are needed, as many patients still experience disease recurrence. The progress that has been made in the treatment of small cell lung cancer has resulted from improved development of multi-modality treatments and participation in clinical trials. Future progress in the treatment of small cell lung cancer will result from continued participation in appropriate clinical trials. There are several areas of active exploration aimed at improving the treatment of small cell lung cancer.

New Chemotherapy Regimens: Identification of effective new chemotherapy drugs is an active area of research. Amrubicin, for example, has shown promising results in Phase II clinical trials among patients with relapsed small cell lung cancer.1 The drug can also, however, cause severe side effects.

Biologic Therapy: Following cancer treatment with chemotherapy, patients often achieve a complete remission (disappearance of the cancer). Unfortunately, many patients in remission will later experience a relapse of their cancer. This is because not all of the cancer cells were destroyed. Doctors refer to this as a state of “minimal residual disease”. Many doctors believe that applying additional cancer treatments when only a few cancer cells remain represents the best opportunity to prevent the cancer from returning. Biologic agents that stimulate the immune system are being evaluated to prevent or delay relapses. Examples of biologic agents that can be used to treat minimal residual cancer include cytokines, vaccines and monoclonal antibodies. Large multi-institutional and several smaller clinical trials are ongoing to evaluate these new approaches.

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.

Reference:

1 Ettinger DS, Jotte R, Lorigan P et al. Phase II study of amrubicin as second-line therapy in patients with platinum-refractory small-cell lung cancer. Journal of Clinical Oncology. 2010; 28(15):2598-603.

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