Treatment of small cell lung cancer.

Small cell lung cancer (SCLC) is a very chemo- and radiosensitive systemic disease. Combination chemotherapy produces a survival advantage resulting in median survival of 9 to 12 months in extensive disease. Platinum and etoposide in combination with concurrent, early, hyperfractionated chest radiotherapy, in patients with limited disease, produces median survival of 20 months. Prophylactic cranial radiotherapy, in patients with complete response following induction chemotherapy, reduces the incidence of brain metastases and improves survival. Triplet combinations, dose intensification, and maintenance therapy have not demonstrated meaningful survival improvements. Recurrent disease can be treated with the same chemotherapy, as in the first line treatment if the progression-free interval exceeds 3 months; otherwise, monotherapy with a novel compound is suggested. Camptothesins (topotecan, irinotecan) appear the most promising new compounds and may become first-line agents for SCLC in the near future. Molecular advances have provided many new targets for SCLC therapy. Many studies, ongoing or planned, evaluate the effectiveness of new agents developed to attack these targets.