According to a study published in the journal Chest, treatment of small cell lung cancer with high-dose chemotherapy followed by peripheral blood stem cell transplantation is feasible and appears to be well tolerated.

Small cell lung cancers (SCLC) account for 20%-25% of all lung cancers and are primarily diagnosed in smokers or former smokers. They differ from other types of lung cancer in that they spread very quickly throughout the body via the blood and lymphatic system.

Accurate staging of SCLC is essential before definitive therapy can begin. A simple staging system is used to separate SCLC into two stages: limited and extensive:

  • Limited SCLC is confined to a single location in the chest and is not detectable outside the lung.
  • Extensive SCLC has spread to both lungs or is detectable beyond the lungs.

High-dose chemotherapy kills more cancer cells than moderate doses. However, high-dose chemotherapy also results in more side effects, particularly to the blood-producing hematopoietic stem cells. Hematopoietic stem cells are immature blood cells produced in the bone marrow that mature into red blood cells (which carry oxygen to tissues), white blood cells (which fight infection), and platelets (which aid in blood clotting). Procedures such as bone marrow transplantation or peripheral blood stem cell transplantation (PBSCT) are used to restore stem cells destroyed by high-dose therapy. PBSCT involves the infusion of stem cells collected from the bloodstream.

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Because high-dose chemotherapy coupled with PBSCT has the potential to improve cancer outcomes, researchers in Japan assessed the feasibility of these treatments in a small sample of SCLC patients. The study enrolled 18 patients, 11 of whom had limited SCLC. After treatment with conventional chemotherapy or chemoradiotherapy, patients received two cycles of treatment with high doses of the chemotherapy drugs ifosfamide, carboplatin, and etoposide, followed by PBSCT.

Fifteen of the 18 patients received both cycles of high-dose therapy and PBSCT, and three patients received one cycle. Severe adverse effects of treatment, which included diarrhea and kidney problems, were infrequent. Researchers reported the following responses to treatments:

  • All patients showed some reduction in detectable cancer after treatment.
  • 83% had complete or near-complete disappearance of detectable cancer.
  • The two- and five-year survival rates were: 72% and 55% in patients with limited SCLC43% and 0% in patients with extensive SCLC

The researchers conclude that two cycles of high-dose chemotherapy and PBSCT is well-tolerated and feasible for the treatment of patients with SCLC. Patients with SCLC may wish to talk with their doctor about the risks and benefits of participating in a clinical trial further evaluating this or other therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.cancerconsultants.com.

Reference: Iwasaki Y, Nagata K, Nakanishi M et al. Double-Cycle, High-Dose Ifosfamide, Carboplatin, and Etoposide Followed by Peripheral Blood Stem-Cell Transplantation for Small Cell Lung Cancer. Chest. 2005;128:2268-2273.

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