Overview

When lung cancer has been detected or has returned following an initial treatment with surgery, radiation and/or chemotherapy, it is referred to as recurrent or relapsed.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of recurrent small cell lung cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Historically, patients experiencing a recurrence of small cell lung cancer have had few treatment options. Recently, several newer chemotherapeutic drugs have demonstrated a substantial ability to kill small cell lung cancer cells in patients with recurrent cancer. Developing and exploring single or multi-agent chemotherapy agents as a treatment approach for patients with recurrent or relapsed small cell lung cancer is an area of active investigation.

Many conventional chemotherapy drugs are administered intravenously (IV). Chemotherapy drugs that can be taken orally (by mouth) offer patients a more convenient approach to treatment. An oral capsule formulation of the chemotherapy drug Hycamtin® (topotecan) was approved by the U.S. Food and Drug Administration (FDA) in October, 2007 for the treatment of relapsed SCLC.[1]

The clinical trial that prompted the FDA approval of oral Hycamtin included 141 patients with SCLC who had received prior chemotherapy.[2] Patients were not considered eligible for IV therapy. One group of patients was treated with best supportive care (care to maintain quality of life and reduce symptoms), and one group was treated with Hycamtin plus best supportive care. Median survival was roughly 14 weeks among patients treated with best supportive care alone and roughly 26 weeks among patients treated with Hycamtin and best supportive care. Low levels of blood cells and nausea were the most common side effects associated with Hycamtin.

Strategies to Improve Treatment

While progress has been made in the treatment of small cell lung cancer, better treatment strategies are needed, as many patients still experience disease recurrence. The progress that has been made in the treatment of small cell lung cancer has resulted from improved development of multi-modality treatments and participation in clinical trials. Future progress in the treatment of small cell lung cancer will result from continued participation in appropriate clinical trials. There are several areas of active exploration aimed at improving the treatment of small cell lung cancer.

Phase I Trials: New anti-cancer therapies continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and whether the drug has any anti-cancer activity in patients with lung cell cancer.

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials.

Biologic Therapy: Following cancer treatment with chemotherapy, patients often achieve a complete remission (disappearance of the cancer). Unfortunately, many patients in remission will later experience a relapse of their cancer. This is because not all of the cancer cells were destroyed. Doctors refer to this as a state of “minimal residual disease”. Many doctors believe that applying additional cancer treatments when only a few cancer cells remain represents the best opportunity to prevent the cancer from returning. Biologic agents that stimulate the immune system are being evaluated to prevent or delay relapses. Examples of biologic agents that can be used to treat minimal residual cancer include cytokines, vaccines and monoclonal antibodies. Large multi-institutional and several smaller clinical trials are ongoing to evaluate these new approaches.

Gene Therapy: Currently, there are no gene therapies approved for the treatment of lung cancer. Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a dysfunctional gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death or efforts to make the immune system kill cancer cells. A few gene therapy studies are being carried out in patients with lung cancer. If successful, these therapies could be applied to patients with earlier stage disease.

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed. For more information, go to Managing Side Effects.

Photodynamic Therapy: Photodynamic treatment is now in clinical trials for patients with recurrent SCLC whose cancer is causing endobronchial obstruction. Photodynamic therapy works through the use of a photosensitizing agent and light. The photosensitizing agent is typically comprised of a porphyrin, which is a naturally occurring substance in the body involved in a variety of biological processes. The photosensitizing agent is injected into a patient’s vein a couple of hours prior to surgery. During this time, the agent selectively collects in rapidly growing cells such as cancer cells. During surgery, the physician applies a certain wavelength of light through a hand held wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that accumulates in the cancer cells and ultimately destroys them.

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