Strategies to Improve Treatment of Limited Small Cell Lung Cancer

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

Researchers are currently investigating new treatments for limited small cell lung cancer. Participation in trials of these treatments will lead to improved therapies. If you wish to participate in a clinical trial, please talk to your doctor about the potential benefits and side effects of the treatment.

Supportive Care: Supportive care refers to treatments designed to prevent and control the side effects of cancer and its treatment. Side effects not only cause patients discomfort, but also may prevent the optimal delivery of therapy at its planned dose and schedule. In order to achieve optimal outcomes from treatment and improve quality of life, it is imperative that side effects resulting from cancer and its treatment are appropriately managed.

New Combination Chemotherapy Regimens - Recently, a combination of Camptosar^® (irinotecan) and Platinol^® (cisplatin) chemotherapy demonstrated improved survival time in patients with extensive small cell lung cancer when compared with the previous "standard regimen" of Platinol and etoposide. Clinical trials are ongoing to evaluate Camptosar^® combined with Platinol and other anticancer therapies to improve the treatment of limited stage disease. In addition to Camptosar, other chemotherapy agents, including paclitaxel and Ifex® (ifosfamide), have also been combined with etoposide and platinum compounds, producing three-drug regimens. These three-drug regimens can be administered safely, produce higher response rates and may improve survival rates compared to previous two-drug regimens.

• High-Dose Chemotherapy - High-doses of chemotherapy are more effective at killing cancer cells than lower doses. However, high-dose chemotherapy (HDC) destroys many other cells in the body, including stem cells. Stem cells are immature blood cells produced in the bone marrow which mature into either red blood cells, which carry oxygen to tissues; white blood cells, which fight infection; and platelets, which aid the blood in clotting. A stem cell transplant (SCT) is a procedure that replaces the stem cells that are destroyed by high-dose chemotherapy and/or radiation therapy with healthy stem cells. There are two main types of stem cell transplants. Autologous stem cell transplants use a patient’s own stem cells, which are collected prior to the high-dose treatment and then re-infused after the treatment. Allogeneic stem cell transplants use stem cells collected from the blood or bone marrow of a related or unrelated donor. Early attempts at using very high doses of chemotherapy and bone marrow transplant produced very high cancer response rates, but the treatment was associated with significant side effects. In the 1990s, several technologic advances have made high-dose chemotherapy safer and easier to deliver. This treatment approach continues to be evaluated at some cancer centers.
  
• Gene Therapy - Currently, there are no gene therapies approved for the treatment of lung cancer. Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a dysfunctional gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death or efforts to make the immune system kill cancer cells. A few gene therapy studies are being carried out in patients with lung cancer. If successful, these therapies could be applied to patients with earlier stage disease.
  
• Photodynamic Therapy - Photodynamic treatment is now in clinical trials for patients with extensive SCLC whose cancer is causing endobronchial obstruction. Photodynamic therapy works through the use of a photosensitizing agent and light. The photosensitizing agent is typically comprised of a porphyrin, which is a naturally occurring substance in the body involved in a variety of biological processes. The photosensitizing agent is injected into a patient’s vein a couple of hours prior to surgery. During this time, the agent selectively collects in rapidly growing cells such as cancer cells. During surgery, the physician applies a certain wavelength of light through a hand held wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that accumulates in the cancer cells and ultimately destroys them.