Treatment update in small-cell lung cancer: from limited to extensive disease.

OPINION STATEMENT: Small-cell lung cancers are aggressive tumors, often discovered with widespread metastases that include brain involvement. For patients with limited-stage disease, the standard of care is platinum-doublet chemotherapy (often etoposide) with concurrent radiation. Concurrent chemoradiotherapy can be difficult when given upfront, sometimes preventing on-time completion of later chemotherapy cycles. Recent data support giving concurrent chemoradiotherapy following 1 or 2 cycles of chemotherapy alone. For patients with extensive disease, chemotherapy alone remains the standard of care. For patients with limited or extensive disease who achieve clinical benefit from primary therapy, consideration of prophylactic cranial radiation should be made. Despite aggressive use of these treatments, most patients will have life-threatening disease return, sometimes very soon after finishing treatment. For those patients who are candidates for additional systemic treatment, several single-agent options exist, such as topotecan, paclitaxel, or even consideration of retreating with the same initial regimen depending on how effective it was. All patients with SCLC should be considered for clinical trials, because this remains our greatest hope for finding more effective therapies.