Small Cell Lung Cancer: Current and Future Strategies
1. Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece;
2. Oncology Department, “G. Papageorgiou” University Hospital, Thessaloniki, Greece.
3. Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, China.
4. Medical Clinic I, ''Fuerth'' Hospital, University of Erlangen, Fuerth, Germany.
5. Forensic Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
6. University Pulmonary Department-Interventional Unit, “Ruhrland” Clinic, University of Duisburg-Essen, Essen, Germany.
7. Thoracic Surgery Department, “Theageneio” Anticancer Hospital, Thessaloniki, Greece;
8. Ear, Nose and Throat Department, “Saint Luke” Private Hospital, Panorama, Thessaloniki, Greece;
9. Second Pulmonary Clinic, 'Sotiria' Chest Diseases Hospital, Athens, Greece.
Small cell lung cancer (SCLC) represents approximately 15% of all lung cancer diagnoses and over the last 20 years, in the Western world, the proportion of patients with SCLC has decreased to 13% due to world campaign for smoking cessation. Due to high growth fraction of the disease, to early dissemination with widespread metastases and also to early development of drug resistance, the treatment of SCLC remains discouraging. The median survival time without treatment is 2-4 months and with treatment the 5-year survival rate remains low at <7% overall and the most of the patients relapse within one year after first-line treatment. Chemotherapy with a platinum regimen and etoposide is the gold of standard of treatment for limited (LD) and extensive disease (ED), by adding radical thoracic radiotherapy for patients with good performance status, with LD. The new TNM classification should be used also for SCLC. For the patients who have any response is indicated the prophylactic cranial irradiation (PCI) due to high risk of brain metastases. The benefit from second-line therapy is limited and maintenance therapy did not appear to improve overall survival (OS) or progression free survival (PFS) for patients with SCLC. Many targeted agents have been investigated in LD and ED, almost all of them in unselected populations, but also with pessimistic results. Due to unchanged therapeutic options for almost four decades, is required desperately to understand better the molecular basis of SCLC and to proceed in to clinical trials for new drugs and targeted agents.
Keywords: Small cell lung cancer, strategies