Cancer Treatment Today

Small cell lung cancer (SCLC) is different and distinct from other lung cancers, called non–small-cell lung cancers (NSCLCs), because SCLC exhibits aggressive behavior, with rapid growth, early spread to distant sites, exquisite sensitivity to chemotherapy and radiation, and frequent association with distinct paraneoplastic syndromes.
Patients with disease confined to one hemithorax, with or without mediastinal, contralateral hilar, or ipsilateral supraclavicular or scalene lymph nodes are considered to have limited-stage disease.Management of limited-stage SCLC involves combination chemotherapy, usually with a platinum-containing regimen, and concurrent or subsequent chest radiation therapy. If the patient achieves a complete remission, he or she may be offered prophylactic cranial irradiation. The combination of cisplatin and etoposide (PE) currently is the most widely used regimen in both limited- and extensive-stage SCLC. Phase III studies suggest that irinotecan is as effective as etoposide with cisplatin. Carboplatin is often substituted for cisplatin and this is supported by NCCN.

A phase 2 study found Taxol/carboplatin insufficiently active to warrant comparison to etoposide/cisplatin in phase III trials. NCCN 9SCL-B,1) does not list this regimen. It recommends irinotecan based regimns. NCI (PDQ) recommends: 1.Combination chemotherapy with or without PCI given to patients with complete responses: •EP or EC: etoposide plus cisplatin or carboplatin.Other regimens that appear to produce similar survival outcomes but have been studied less extensively or are in less common use include:

•CAE/CDE: cyclophosphamide plus doxorubicin plus etoposide.
•ICE: ifosfamide plus cisplatin plus etoposide.
•Cisplatin plus irinotecan.
•Cyclophosphamide plus doxorubicin plus etoposide plus vincristine.
•CEV: cyclophosphamide plus etoposide plus vincristine.

Accordingly, I do not conider Taxol/carboplatin to be med. necessary. Taxol is being studied in three drug regimens that include topotecan or irnotecan.

Christopher G. Azzoli, Sherman Baker, Jr., Sarah Temin, William Pao, Timothy Aliff, Julie Brahmer, David H. Johnson, Janessa L. Laskin, Gregory Masters, Daniel Milton, Luke Nordquist, David G. Pfister, Steven Piantadosi, Joan H. Schiller, Reily Smith, Thomas J. Smith, John R. Strawn, David Trent, Giuseppe GiacconeASCO Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small Cell Lung Cancer Focused Update of Recommendation A6 published in Journal of Clinical Oncology, Vol 29, No 28 (October), 2011: 3825-3831. Full Guideline published in Journal of Clinical Oncology, Vol 27, No 36 (December), 2009: 6251-6266

http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf,

C Gridelli1et al ,Published online 3 January 2001
Carboplatin plus paclitaxel in extensive small cell lung cancer: a multicentre phase 2 studyBritish Journal of Cancer (2001) 84, 38–41

M. Sørensen et al, Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up  Ann Oncol (2010) 21 (suppl 5): v120-v125. 1

http://www.cancer.gov/cancertopics/pdq/treatment/small-cell-lung/healthprofessional/page6

Tai P, Yu E, Battista J, Van Dyk J: Radiation treatment of lung cancer-patterns of practice in Canada. Radiother Oncol 2004 May; 71(2): 167-74

Takada M, Fukuoka M, Kawahara M, et al: Phase III randomized study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Onclology Group Study 9104. J Clin Oncol 2002; 20: 3054-60