Treatment of recurrent small cell lung cancer

Lung cancer is the most common cause of cancer death in men and women in North America. A recent analysis of the Surveillance, Epidemiology and End Results database demonstrated that the proportion of small cell lung cancer (SCLC) decreased from 17.4% in 1986 to 13.8% in 1998 [1]. SCLC has a very aggressive course, with approximately 60% to 70% of patients having disseminated (extensive-stage) disease at presentation [2]. SCLC is initially very chemotherapy sensitive, with 60% to 90% of patients with limited-stage disease responding to first-line therapy, and 40% to 70% achieving a complete response (CR) [2]. Despite the high rate of response, recurrence rates are high and median survival times range from only 12 to 20 months, with only a small percentage of patients living beyond 5 years (6%-12%). For extensive disease, overall response rates range from 40% to 70% and the median survival time is lower in this population (7 to 11 months). Less than 5% of extensive-disease patients live beyond 2 years [2]. At the time of recurrence, many patients are potential candidates for further therapy. Although second-line chemotherapy has been shown to produce tumor regression, responses are usually short lived: the median survival is rarely more than 12 months and usually less than 6 months after second-line therapy. Although treatment for recurrent SCLC has been Studied extensively, this has been primarily within the context of phase 11 trials. Most of the studies discussed in this article evaluated second-line chemotherapy, although some studies included patients who received third- or fourth-line chemotherapy. This article reviews treatment for recurrent SCLC and is based on an evidence summary of chemotherapy for relapsed SCLC that was written by the authors and is being developed by the Practice Guidelines Initiative of the Cancer Care Ontario Program in Evidence-based Care. When completed, the evidence summary will be posted at http://www.cancercare.on.ca/access_PEBC.htm. Since the mid-1980s, it has been standard practice in North America and much of Europe to treat most patients with a platinum analog and etoposide (E) as first-line treatment. Therefore, studies published before 1985 will not be discussed in this review because they do not represent the patient population that would be receiving second-line therapy today.