TREATMENT OF SMALL-CELL LUNG-CANCER - THE STATE-OF-THE-ART

Many innovations have been tested to improve the power of chemotherapy for SCLC including: drug diversity enhancement, dose and dose-intensi ty escalation, incorporation of new agents, and resistance modificatio n. Although superiority of combination chemotherapy over monotherapy h as been shown, clinical trials have failed to demonstrate a clearly su perior multiagent regimen. When dose and dose-intensity are diminished from standard levels, the effect is detrimental for both limited and extensive stage SCLC. Trials of dose and dose-intensity above standard levels have not yet shown advantages for patients with extensive stag e SCLC. However, the only two randomized trials of chemotherapy dose e scalation for limited SCLC show statistically significant survival ben efits. The optimal intensity of chemotherapy for limited SCLC has not been defined. State-of-the-art chemotherapy for extensive SCLC could b e CAV, EP, or CAV/EP but EP has generally been favored because it is a ssociated with less myelotoxicity and four cycles are considered adequ ate rather than 6 cycles of the others. EP is widely regarded as state -of-the-art chemotherapy for limited SCLC particularly because this re gimen can be integrated with concurrent thoracic irradiation with acce ptable toxicity. Early thoracic irradiation with concurrent EP chemoth erapy is state-of-the-art treatment for limited SCLC, however, it must be conceded that EP has never been shown to be superior to any other chemotherapy regimen in a phase III trial of either limited or extensi ve SCLC. Current state-of-the-art treatment for limited SCLC can resul t in actual 5-year survival rates of at least 20%; declaration of a st atistically significant improvement will require sample sizes than mos t clinical trials performed to date. (C) 1997 Elsevier Science Ireland Ltd.