Treatment Options for Small Cell Lung Cancer by Stage

Small cell lung cancer is most recently being classified into stages in the same way that non-small cell lung cancer is. However, National Cancer Institute treatment guidelines still organize treatment options by whether the small cell lung cancer is limited to the lung or has spread more extensively:1,2,3,4

Limited-stage disease

  • Combination chemotherapy
  • Combination chemotherapy and external radiation therapy
  • Surgery, followed by chemotherapy or chemoradiotherapyTreatment that combines chemotherapy with radiation therapy
  • Radiation therapy to the brain for patients who have had a complete responseThe disappearance of all signs of cancer in response to treatment; this does not always mean the cancer has been cured, to prevent the spread of cancer to the brain; also known as prophylactic cranial irradiationRadiation therapy to the brain to reduce the risk of cancer spreading to that organ
  • Clinical trials of new chemotherapy, surgery, and radiation treatments

Extensive-stage disease

  • Combination chemotherapy
  • Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life
  • Radiation therapy to the brain in patients who have had a complete response, to prevent the spread of cancer to the brain; also known as prophylactic cranial radiation
  • Radiation therapy to the checks in patients who respond to chemotherapy
  • Immune checkpoint inhibitors, in combination with chemotherapy for first-line treatment, following progression on other treatments, or for tumors with a high TMB (tumor mutational burden)
  • Alkylating drug  (a form of chemotherapy)—lurbinectedin (ZepzelcaTM )—for patients who have progressed on or after platinum-based chemotherapy
  • Clinical trials of new treatment options

Recurrent disease

  • Chemotherapy
  • Radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Checkpoint inhibitors
  • Laser therapy, stent placement to keep airways open, and/or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Clinical trial options with new drugs

Updated February 18, 2021


References

1.  Small Cell Lung Cancer Treatment (PDQ®) — Patient Version. National Cancer Institute website. https://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq#_77. Updated May 21, 2020. Accessed February 18, 2021.
2.   NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) — Small Cell Lung Cancer. Version 2.2021 . https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf. Accessed February 18, 2021.
3.  ZepzelcaTM (lurbinectedin injection [package insert]. 2020. Jazz Pharmaceuticals, Inc. Palo Alto, CA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213702s000lbl.pdf. Revised June 2020. Accessed February 18, 2021.
4. ClinicalTrials.gov. NIH U.S. National Library of Medicine website. https://clinicaltrials.gov/. Accessed February 18, 2021.

 

 

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