Treatment of small cell lung cancer patients

Small cell lung cancers, comprising approximately 20% of lung cancers, are rapidly growing and disseminating carcinomas which are initially chemosensi tive but acquire drug resistance during the course of disease. Thus, outcom e is poor with median survival of 10-16 months for patients with limited an d 7-11 months for patients with extensive disease. Polychemotherapy with es tablished drugs (platins, etoposide, anthracyclines, cyclophosphamide, ifos famide and Vinca alkaloids) plays the major role in the treatment of this d isease and results in overall response rates between 80%95% for limited dis ease and 60%-80% for extensive disease. Dose-intensified chemotherapy and h igh-dose chemotherapy with peripheral blood progenitor cell support were te sted in several trials but their exact impact on outcome remains to be dete rmined. New drugs including the taxanes (paclitaxel, docetaxel), the topois omerase I inhibitors (topotecan, irinotecan), vinorelbine and gemcitabine a re currently evaluated in clinical trials. In limited disease, thoracic rad iotherapy improves survival and prophylactic cranial irradiation should be administered to those with a reasonable chance of cure.