Small Cell Lung Cancer: Advances in Diagnosis and Management

Ayushi F. Chauhan, MD; Stephen V. Liu, MD

Disclosures

Semin Respir Crit Care Med. 2020;41(3):435-446. 

In This Article

Abstract and Introduction

Abstract

Small cell lung cancer (SCLC) is an aggressive subtype of lung cancer characterized by rapid growth and early spread. It is a highly lethal disease that typically is diagnosed at a late stage. Surgery plays a very small role in this cancer, and management typically involves chemotherapy, delivered with thoracic radiation in early-stage disease. Platinum-based chemotherapy is initially very effective, inducing rapid and often deep responses. These responses, though, are transient, and upon relapse, SCLC is highly refractory to therapy. Immunotherapy has shown promise in delivering meaningful, durable responses and the addition of immunotherapy to first-line chemotherapy has led to the first improvements in survival in decades. Still, the disease remains difficult to manage. Incorporating radiation therapy at specific points in patient management may improve disease control. The development of predictive biomarkers and novel targeted therapies will hopefully improve options for patients in the near future. This review focuses on the current standards of care and future directions.

Introduction

Small cell lung cancer (SCLC) is an exceptionally lethal subtype of lung cancer whose biology and clinical management are quite distinct from those of the more common non-SCLC (NSCLC). Histologically, SCLC is a high-grade neuroendocrine tumor.[1] It represents approximately 13% of all lung cancer cases in the United States but accounts for a disproportionately high number of lung cancer deaths.[2] SCLC is an aggressive malignancy, characterized by a rapid doubling time and early metastatic potential. Disease prognosis is grim with metastatic SCLC having a median survival of 8 to 10 months and a 5-year overall survival (OS) of less than 2 percent.

There is a strong correlation between SCLC and smoking, and their geographic and epidemiologic trends often mirror each other. In the United States, the incidence of SCLC has been declining over recent years coinciding with a decrease in smoking and changes in cigarette composition.[2] Similarly, the proportional incidence in females has been rising, again, attributable to changing gender distribution of cigarette smoking, with a near 1:1 distribution of new SCLC cases among men and women.[2,3]

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