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Chemotherapy

Chemotherapy uses powerful medications to kill cancer cells. These medications may be taken by mouth (orally), but they are usually injected into a vein (IV).

Chemotherapy is a systemic treatment because the medications enter the bloodstream, travel throughout the body, and kill cancer cells wherever they are. However, some normal cells are also killed. This is responsible for some of the side effects of chemotherapy.

Chemotherapy is usually given at intervals to ensure that the bone marrow has recovered before the next dose of chemotherapy is given.

Extensive research and clinical trials have identified different chemotherapy medications in the last 3 decades for the treatment of lung cancer. Response rates with these medications have been found to be more than 80% in persons with small-cell lung cancer who were previously untreated.

Some medications are used alone, while some are used in combination with others for greater effectiveness. An oncologist (cancer specialist) recommends chemotherapy specific to the patient’s condition.

Chemotherapy medications used for the treatment of small-cell lung cancer include the following:

• Etoposide (Toposar, VePesid) is an effective antitumor medication. It slows or stops the growth of cancer cells in the body by causing breakage in the DNA (genetic material) strand. It may be given as an IV injection or as a pill.



• Cyclophosphamide (Cytoxan, Neosar) interferes with the growth of normal cells and cancer cells. It slows the growth of cancer cells and their spread in the body. It may be given as an IV injection or as a pill.



• Doxorubicin (Adriamycin, Rubex) causes destruction of DNA, which slows or stops the growth and spread of cancer cells in the body. It is an IV medication.



• Vincristine (Oncovin) is a plant-based compound. It causes cell death by interfering with the way genetic material (DNA) multiplies in the cell. It is only available as an IV medication.



• Topotecan (Hycamtin) interferes with the growth of cancer cells by inhibiting the duplication of DNA. It is an IV medication.



• Paclitaxel (Taxol) interferes with the growth of cancer cells and slows their growth and spread in the body. It is an IV medication.



• Cisplatin (Platinol) causes breakage in the DNA (genetic material) strand and interferes with cell growth. It is an IV medication.



• Carboplatin (Paraplatin) is similar to cisplatin. It also causes breakage in the DNA (genetic material) strand and interferes with cell growth. Its effectiveness is similar to cisplatin, but it is better tolerated and has lesser side effects.



• Irinotecan (Camptosar) acts in a similar manner as topotecan to decrease cancer cell growth by causing damage to cancer cell DNA. It is an IV medication.

Commonly used chemotherapy regimens in small-cell lung cancer include the following:

• CAV (cyclophosphamide, doxorubicin [Adriamycin], and vincristine)



• PE (cisplatin and etoposide)



• CAVE (cyclophosphamide, doxorubicin [Adriamycin], vincristine, and etoposide)



• PEC (paclitaxel, etoposide, and carboplatin)



• Topotecan alone



• Etoposide alone



• Cisplatin and irinotecan

Treatment of limited-stage small-cell lung cancer

• Currently, cisplatin, etoposide, vincristine, doxorubicin, and cyclophosphamide are the most commonly used medications for the treatment of persons with small-cell lung cancer.



• Standard treatment of small-cell lung cancer involves combination chemotherapy with a cisplatin-containing regimen. Treatment cycles are repeated every 3 weeks. People generally receive treatment for 4-6 cycles.



• The combination of cisplatin and etoposide (PE) is the most widely used regimen in both limited- and extensive-stage small-cell lung cancer. 



• More recently, paclitaxel and topotecan have emerged as effective medications in persons with small-cell lung cancer who have not been previously treated. The response rates range from approximately 40% with topotecan to 50% with paclitaxel.



• Some doctors start radiotherapy to the chest as early as possible, while others may give it with the fourth cycle of chemotherapy.



• Radiation and chemotherapy: Sequential-radiation treatment may be given, followed by chemotherapy.



• If the patient is completely cured of the cancer, radiation therapy may be given to the patient’s skull to reduce the risk of small-cell lung cancer spreading to his or her brain. This is called prophylactic cranial irradiation (PCI). It is usually given after the patient has completed the full chemotherapy and radiotherapy (to the thorax) regimen.

• Persons with extensive-stage small-cell lung cancer are treated with combination chemotherapy. Currently, the combination of cisplatin or carboplatin and etoposide (PE) is the most widely used regimen.



• Radiation therapy may be used for relief of the following symptoms:
  
  
  • Bone pains
  
  
  
  • Compression of the food pipe (esophagus), windpipe, or superior vena cava caused by tumors

• Persons who have a relapse of small-cell lung cancer have an extremely poor prognosis. 



• If the disease does not respond to treatment or progresses on initial treatment (ie, refractory disease) or if the disease relapses within 6 months of completion of therapy, the person has little chance of responding to additional chemotherapy.



• Persons whose cancer does not progress for more than 6 months may be given additional chemotherapy.



• Persons with relapsed or refractory small-cell lung cancer may enroll in clinical trials. For information about ongoing clinical trials, visit the National Cancer Institute's Clinical Trials.

Other drugs may also be given to prevent and treat adverse effects of radiation or chemotherapy, such as nausea or vomiting. Pain medications are also important to relieve pain due to cancer or surgery.

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