What is the optimal systemic therapy and duration to be used for the treatment of limited stage small cell lung cancer?

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What is the optimal systemic therapy and duration to be used for the treatment of limited stage small cell lung cancer?

Meta-analyses have demonstrated that platinum based regimens are associated with greater response rates but differing toxicity profiles relative to non-platinum regimens in patients with limited stage disease.[1][2]

The latter may represent alternative therapy, however, their role in chemoradiation for limited stage disease has not been assessed. In this regard the platinum-etoposide regimen is considered the standard chemotherapy backbone for patients with limited stage small cell lung cancer.

The evidence for the benefit of consolidation or maintenance therapy post response to induction therapy is controversial with conflicting results from phase III trials[3][4][5] and meta-analyses.[6]

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Evidence summary and recommendations

Evidence summary Level References
Platinum-Etoposide regimens remain the gold standard chemotherapy in patients with limited stage small cell lung cancer, particularly where concurrent radiation therapy is deemed appropriate I [1], [2]
Maintenance or consolidation therapy post response to initial beyond four cycles of chemotherapy. I, II [6], [2], [3]
Recommendation Grade
Platinum-etoposide regimens are considered the standard systemic chemotherapy in the treatment of limited stage small cell lung cancer.
B
Recommendation Grade
Therapy beyond the standard four cycles of induction chemotherapy cannot be recommended.
A
Practice point(s)

It is advisable to use platinum plus etoposide for four cycles in patients with limited stage small cell lung cancer.

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References

  1. 1.0 1.1 Amarasena IU, Walters JA, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regimens for small cell lung cancer Cochrane Database Syst Rev 2008 Oct 8;(4):CD006849 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18843733].
  2. 2.0 2.1 2.2 Rossi A, Garassino MC, Cinquini M, Sburlati P, Di Maio M, Farina G, et al. Maintenance or consolidation therapy in small-cell lung cancer: a systematic review and meta-analysis Lung Cancer 2010 Nov;70(2):119-28 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20188431].
  3. 3.0 3.1 Lee SM, Woll PJ, Rudd R, Ferry D, O'Brien M, Middleton G, et al. Anti-angiogenic therapy using thalidomide combined with chemotherapy in small cell lung cancer: a randomized, double-blind, placebo-controlled trial J Natl Cancer Inst 2009 Aug 5;101(15):1049-57 [Abstract available at HTTP://WWW.NCBI.NLM.NIH.GOV/PUBMED/19608997].
  4. Shepherd FA, Giaccone G, Seymour L, Debruyne C, Bezjak A, Hirsh V, et al. Prospective, randomized, double-blind, placebo-controlled trial of marimastat after response to first-line chemotherapy in patients with small-cell lung cancer: a trial of the National Cancer Institute of Canada-Clinical Trials Group and the European Organization for Research and Treatment of Cancer J Clin Oncol 2002 Nov 15;20(22):4434-9 [Abstract available at HTTP://WWW.NCBI.NLM.NIH.GOV/PUBMED/12431965].
  5. Giaccone G, Debruyne C, Felip E, Chapman PB, Grant SC, Millward M, et al. Phase III study of adjuvant vaccination with Bec2/bacille Calmette-Guerin in responding patients with limited-disease small-cell lung cancer (European Organisation for Research and Treatment of Cancer 08971-08971B; Silva Study) J Clin Oncol 2005 Oct 1;23(28):6854-64 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16192577].
  6. 6.0 6.1 Bozcuk H, Artac M, Ozdogan M, Savas B. Does maintenance/consolidation chemotherapy have a role in the management of small cell lung cancer (SCLC)? A metaanalysis of the published controlled trials Cancer 2005 Dec 15;104(12):2650-7 [Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16284984].

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Appendices

Further resources

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