Intensive chemotherapy plus concurrent chest radiation with stem cell support produces high anti-cancer response rates and improves survival over standard therapy for patients with limited disease small cell lung cancer, according to results recently presented at the 37th Annual Meeting of the American Society of Clinical Oncology.
Small cell lung cancer (SCLC) accounts for approximately one-quarter of all lung cancers. This cancer differs from other types of lung cancer in that it tends to spread throughout the body very quickly through the blood and lymph vessels. Limited SCLC refers to cancer that is present in only one location in the chest. The most common form of treatment for patients with limited SCLC is combination chemotherapy usually consisting of etoposide and cisplatin plus radiation to the chest and sometimes preventive radiation to the head.
Since SCLC is an aggressive cancer, different treatment strategies including intensive treatment are ongoing in an attempt to prolong survival in these patients. However, intensive treatment dosages often cannot be completed, as side effects become too severe. One common limiting side effect from aggressive treatment involves low blood cell levels. Stem cells are immature blood cells that are often killed by treatment which normally develop into red blood cells, which carry oxygen to tissues; white blood cells, which are immune cells; and platelets, which aid the blood in clotting. The collection of stem cells from the patient prior to treatment and re-infusion following treatment remedies the situation of low blood cell levels and allows for more aggressive treatment.
Researchers from Switzerland recently conducted a clinical trial evaluating an aggressive treatment regimen consisting of chemotherapy and radiation followed by stem cell support in 18 patients with limited disease SCLC. The clinical trial involved the use of intensive chemotherapy including etoposide, ifosfamide, paclitaxel and carboplatin. Concomitant radiation therapy to the chest was also utilized as a component of the treatment regimen. Stem cells that had been collected prior to treatment were infused back into the patient 48 hours after the initiation of chemotherapy. Granulocyte colony stimulating factor (G-CSF), an agent that stimulates immune cell production, was also utilized as supportive therapy throughout treatment. Fourteen patients in this study were able to complete this intensive therapy. The total anti-cancer response rate to this treatment regimen was 95%. Two years following treatment, 55% of patients had no progression of cancer and the overall survival was 65%. The average progression-free survival was 29 months and the average overall survival has not yet been reached.
These results indicate a significant improvement in both progression-free survival and overall survival for patients with limited disease SCLC over the standard treatment, which produces progression-free survival of approximately 13 months and overall survival of approximately 17 months. Supportive care measures appear to have enabled patients to tolerate this intensive regimen, which ultimately produced superior outcomes. Patients with SCLC may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating this regimen or other promising treatment strategies. Two sources of ongoing information about clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (
Proceedings from the 37th Annual Meeting of the American Society of Clinical Oncology, abstract 1282 , San Francisco, CA, May, 2001)