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Adding a new chemotherapy drug to those already being given to persons with limited small cell lung cancer may potentially improve survival rates, according to a recent study conducted by U.S. researchers at several medical centers. Persons who have limited small cell lung cancer (lung cancer that is confined to 1 area of the chest) are usually treated with radiation therapy as well as chemotherapy with etoposide and cisplatin. These researchers say that the addition of paclitaxel to this chemotherapy combination may improve treatment results.

Small cell lung cancer is characterized by the presence of cancer cells in the lung. The stage of disease may be

limited, with cancer occurring only in 1 lung and surrounding lymph nodes;

extensive, with cancer spreading outside the lung; or

recurrent, referring to cancer that has come back in the lung or other part of the body after treatment. If small cell lung cancer recurs (returns), it is often in the lung or the brain. Depending on the stage of disease, treatment options for persons with small cell lung cancer may include chemotherapy, radiation therapy, surgery, and/or biologic therapy. The most common treatment for

limited small cell lung cancer is chemotherapy (often etoposide and cisplatin) with radiation therapy to the chest, with or without additional radiation therapy to the brain (to prevent cancer recurrence there). Biologic therapies commonly used to help the blood cells recover include Neupogen®, a natural growth factor, which speeds up the production of white blood cells after chemotherapy. Researchers continue to develop new strategies, including new chemotherapy combinations, to improve the effectiveness of treatment.

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Researchers from several medical centers in the United States treated 31 persons who had limited small cell lung cancer with repeat cycles of paclitaxel, etoposide, and cisplatin at 21-day intervals. The patients also received radiation therapy with each treatment cycle, and Neupogen after the first 2 cycles. Of the 28 patients who could be evaluated after treatment, 39% had a complete response and 57% achieved a partial response. The average survival time was 22 months. The average survival time after treatment with etoposide and cisplatin only is about 14 months.

These findings suggest that the combination of paclitaxel, etoposide, and cisplatin is at least as effective as previously studied treatments, with a possible improvement in survival rates. However, a complete response was achieved in fewer than half the patients, indicating that improvements are still needed. Persons with small cell lung cancer may wish to talk with their doctor about the risks and benefits of the paclitaxel/etoposide/cisplatin regimen or of participating in a clinical trial in which other new treatments are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( and the Clinical Trials section and service offered by Cancer ( (

Journal of Clinical Oncology, Vol 18, No 5, pp 1102-1113, 2000)

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