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Chemotherapy (chemo) is treatment with anti-cancer drugs that may be injected into a vein or taken by mouth. These drugs travel through the bloodstream and reach most parts of the body.
Chemo is typically part of the treatment for small cell lung cancer (SCLC). This is because SCLC has usually already spread by the time it is found , so other treatments such as surgery or radiation therapy would not reach all areas of cancer.
Some patients in poor health might not be able to tolerate intense doses of chemo or a combination of drugs. But older age by itself is not a reason to avoid chemo.
Generally, SCLC is treated with combinations of chemo drugs. The combinations used most often are:
Topotecan and lurbinectedin (Zepzelca) are chemo drugs that might be used by themselves in people with SCLC that has spread, especially if they have already tried cisplatin or carboplatin.
Chemo drugs for lung cancer are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting.
Often, slightly larger and sturdier IVs known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines are needed to give chemo. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing. Many different kinds of CVCs are available. The most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 3 or 4 weeks long, and initial treatment is typically 4 to 6 cycles. The schedule varies depending on the drugs used. For example, some drugs are given only on the first day of the chemo cycle. Others are given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
For advanced cancers, the initial chemo combination is often given for 4 to 6 cycles, sometimes in combination with an immunotherapy drug. Beyond this, doctors might also recommend extending treatment with a single immunotherapy drug, for people who have had a good response to their initial chemotherapy or have had no worsening of their cancer.
If the cancer progresses (gets worse) during treatment or returns after treatment is finished, other chemo 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.)
SCLC that progresses or comes back can be hard to treat, so taking part in a clinical trial of newer treatments might be a good option for some people.
Chemo drugs can cause side effects. These depend on the type and dose of drugs given and how long they are taken. Some common side effects of chemo include:
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
These side effects usually go away after treatment, but there are also often ways to lessen them. For example:
Some drugs can have specific side effects. For example:
Be sure to report any side effects you notice during chemo to your medical team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Araujo LH, Horn L, Merritt RE, Shilo K, Xu-Welliver M, Carbone DP. Ch. 69 - Cancer of the Lung: Non-small cell lung cancer and small cell lung cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Hann CL, Wu A, Rekhtman N, Rudin CM. Chapter 49: Small cell and Neuroendocrine Tumors of the Lung. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.
National Cancer Institute. Physician Data Query (PDQ). Health Professional Version. Small Cell Lung Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq on June 12, 2019.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf on June 12, 2019.
Last Revised: February 17, 2021
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