Current Diagnosis and Management of Small-Cell Lung Cancer

Small-cell lung cancer (SCLC) is an aggressive disease with distinct pathological, clinical, and molecular characteristics from non–small-cell lung cancer. SCLC has high metastatic potential, resulting in a clinically poor prognosis. Early concurrent chemo-radiation is the standard of care for limit...

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Bibliographic Details
Published in:Mayo Clinic proceedings 2019-08, Vol.94 (8), p.1599-1622
Main Authors: Wang, Shuhang, Zimmermann, Stefan, Parikh, Kaushal, Mansfield, Aaron S., Adjei, Alex A.
Format: Article
Language:English
Subjects:
Aged
Antibodies, Monoclonal, Humanized - therapeutic use
Antineoplastic Combined Chemotherapy Protocols
Ataxia telangiectasia
Atezolizumab
Biological Products - therapeutic use
Brain research
Cancer metastasis
Cancer therapies
Carboplatin
Carcinoma, Non-Small-Cell Lung - diagnosis
Carcinoma, Non-Small-Cell Lung - mortality
Carcinoma, Non-Small-Cell Lung - therapy
Care and treatment
Chemoradiotherapy - methods
Chemotherapy
Demeclocycline
Development and progression
Diarrhea
Disease Management
Disease-Free Survival
DNA damage
DNA repair
Epidemiology
Etoposide
FDA approval
Female
Homologous recombination
Humans
Immunotherapy
Immunotherapy - methods
Ipilimumab
Irinotecan
Japan
Lung cancer
Lung Neoplasms - diagnosis
Lung Neoplasms - drug therapy
Lung Neoplasms - mortality
Male
Medical diagnosis
Medical prognosis
Medical research
Metastasis
Middle Aged
Monoclonal antibodies
Mortality
Neoplasm Invasiveness - pathology
Neoplasm Staging
Neutropenia
Nivolumab
Platinum
Prognosis
Radiation (Physics)
Risk Assessment
Small cell lung carcinoma
Smoking
Studies
Survival Analysis
Targeted cancer therapy
Thrombocytopenia
TLR9 protein
Toll-like receptors
Topotecan
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Description
Summary:Small-cell lung cancer (SCLC) is an aggressive disease with distinct pathological, clinical, and molecular characteristics from non–small-cell lung cancer. SCLC has high metastatic potential, resulting in a clinically poor prognosis. Early concurrent chemo-radiation is the standard of care for limited-stage SCLC (LS-SCLC). Prophylactic cranial irradiation (PCI) is recommended for patients with LS-SCLC without progression of disease after initial therapy. A combination of etoposide and cisplatin or carboplatin remains the mainstay of first-line treatment for ES-SCLC, with the addition of atezolizumab, now becoming standard. Most SCLCs initially respond to therapy but almost invariably recur. Topotecan and amrubicin (in Japan) remain the primary chemotherapy options for relapsed SCLC. Immunotherapy, including nivolumab with or without ipilimumab, is now available for refractory disease. In general, the poor prognosis of SCLC has not improved significantly for more than 3 decades. Recently, next-generation molecular profiling studies have identified new therapeutic targets for SCLC. A variety of proapoptotic agents, compounds capitalizing on DNA-repair defects, immunotherapy agents, and antibody–drug conjugates are being evaluated in SCLC, with a number of them showing early promise.
ISSN:0025-6196
1942-5546
DOI:10.1016/j.mayocp.2019.01.034