Small-cell lung cancer chemotherapy

Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. Chemotherapy is usually the main treatment for small cell lung cancer (SCLC).

Doctors give chemotherapy in cycles, with a period of treatment (usually 1 to 3 days) followed by a rest period to allow your body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically is 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

Chemotherapy for SCLC generally uses a combination of 2 drugs. The drug combinations most often used for initial chemotherapy for SCLC are:

• Cisplatin and etoposide
• Carboplatin and etoposide
• Cisplatin and irinotecan
• Carboplatin and irinotecan
• Cyclophosphamide, doxorubicin (Adriamycin^®), and vincristine

If the cancer progresses (get worse) during treatment or returns after treatment is finished, different chemotherapy drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to respond to further treatment.)

• If the cancer progresses during treatment or relapses (returns) within 2 to 3 months of finishing treatment, drugs such as topotecan, ifosfamide, paclitaxel, docetaxel, irinotecan, or gemcitabine may be tried.
• If the relapse occurs from 2 to 3 months to 6 months after treatment, topotecan is often the drug of choice. Other drugs that may be tried include irinotecan, the CAV regimen (cyclophosphamide, doxorubicin, and vincristine), gemcitabine, paclitaxel, docetaxel, oral etoposide, or vinorelbine.
• For relapses 6 or more months after treatment, the original chemotherapy regimen may still be effective and can often be tried again.

Possible side effects of chemotherapy

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting.

Some side effects can be more long lasting. For example, drugs such as cisplatin, vinorelbine, docetaxel, or paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy. In most cases this improves after treatment is stopped, but it may be long lasting in some people. For more information, see our document, Peripheral Neuropathy Caused by Chemotherapy.

Also, cisplatin can cause kidney damage (called nephropathy). To help prevent this, doctors give lots of fluid IV before and after each dose of the drug is given.

You should report any side effects you notice while getting chemotherapy to your medical team so that they can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

For more information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.