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. 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.

After failure of systemic therapy, NCCN says: “Clinical trial preferred”. For relapse, not progression but relapse, it recommends several single gents, including topotecan, Taxo,  irinotecan and others. This situation is progression, not relapse. Among them is docetaxel. The 1994 reference that it cites, by SMyth et al, is for a three weekly schedule. This paper reports a phase II trial in patients with previously-treated small cell carcinoma of the lung. 34 patients received 100 mg/m2 of docetaxel in an intravenous infusion given over 1 h every 21 days. Seven partial responses were reported (25% of 28 evaluable patients). Duration of response was 3.5-12.6 months.

A weekly schedule is equivalent to thrice-weekly, as shown by a pashe II study, albeit in non-small cell lung cancer. Weekly docetaxel 35 mg/m2 demonstrated similar efficacy and better tolerability than standard 3-weekly docetaxel 75 mg/m2 .  There was aslo a study by Hainsworth et al  in the elderly patietns with small cell lung cancer that found that weekly administration of docetaxel was found to reduce myelosuppression and other nonhematologic toxicities when compared with administration every 3 weeks.

Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Ann oncol (2010) 21 (suppl 5): v120-v125.

Edward F. Mileset al, Aggressive Palliation in Extensive Stage Small Cell Lung Cancer, Practice Guidelines versus Clinical Practice: A Case Report and Review of the Literature Lung Cancer InternationalVolume 2011 (2011), Article ID 659807

http://www.nccn.org/professionals/physician_gls/PDF/sclc.pdf(2011)

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

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

Wolfgang Schuette et al, Phase III Study of Second-Line Chemotherapy for Advanced Non–Small-Cell Lung Cancer With Weekly Compared With 3-Weekly Docetaxel Journal of Clinical Oncology, Vol 23, No 33 (November 20), 2005: pp. 8389-8395

J D Hainsworth, H A Burris, S Litchy, L H Morrissey, J H Barton, J E Bradof, F A Greco Weekly docetaxel in the treatment of elderly patients with advanced nonsmall cell lung carcinoma. A Minnie Pearl Cancer Research Network Phase II Trial.
Cancer (2000)  Volume: 89, Issue: 2, Pages: 328-333