Chemotherapy for Small Cell Lung Cancer

Chemotherapy (chemo) is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer anywhere in the body.

When might chemotherapy be used?

Chemo is typically part of the treatment for small cell lung cancer (SCLC). This is because SCLC has usually already spread by the time it is found (even if the spread can’t be seen on imaging tests), so other treatments such as surgery or radiation therapy would not reach all areas of cancer.

• For people with limited stage SCLC, chemo is often given along with radiation therapy. This is known as chemoradiation.
• For people with extensive stage SCLC, chemo alone is usually the main treatment (although sometimes radiation therapy is given as well).

Some patients in poor health might not be able to tolerate intense doses of chemo. But older age by itself is not a reason to not get chemo.

Drugs used to treat SCLC

SCLC is generally treated with combinations of chemotherapy drugs. The combinations most often used are:

• Cisplatin and etoposide
• Carboplatin and etoposide
• Cisplatin and irinotecan
• Carboplatin and irinotecan

Doctors give chemo in cycles, with a period of treatment (usually 1 to 3 days) followed by a rest period to allow your body time to recover. Each cycle generally lasts about 3 to 4 weeks, and initial treatment is typically 4 to 6 cycles.

If the cancer progresses (get worse) during treatment or returns after treatment is finished, other chemo drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to respond to further treatment.)

• If cancer returns more than 6 months after treatment, it might respond again to the same chemo drugs that were given the first time, so these can be tried again.
• If the cancer comes back sooner, or if it keeps growing during treatment, further treatment with the same drugs isn’t likely to be helpful. If further chemo is given, most doctors prefer treatment with a single, different drug to help limit side effects. Topotecan, which can either be given into a vein (IV) or taken as pills, is the drug most often used, although others might also be tried.

SCLC that progresses or comes back can be hard to treat, so taking part in a clinical trial of newer treatments might be a good option for some people.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are taken. Some of the more common side effects of chemo include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

These side effects usually go away after treatment. There are often ways to lessen these side effects. For example, drugs can help prevent or reduce nausea and vomiting.

Some drugs can have specific side effects. For example:

• Drugs such as cisplatin and carboplatin can damage nerve endings. This is called peripheral neuropathy. It can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most people this goes away or gets better after treatment is stopped, but it may last a long time in some people.
• Cisplatin can also cause kidney damage. To help prevent this, doctors give lots of IV fluids before and after each dose of the drug is given.