Several years ago, I participated in a clinical trial with a combination of carboplatin and irinotecan for treatment of extensive SCLC, just now being published (abstract here).
The treatment of relapsed SCLC isn’t especially controversial, because this is an area where there aren’t enough breakthroughs. In someone fit enough to perform their own activities of daily living and getting out of the house, the main question is how long it has been since they completed their first line treatment.
In my earliest introductory post about SCLC, I described the typical staging breakdown used clinically, which is essentially divided into limited disease SCLC (LD-SCLC), which is typically treated with chemo and chest radiation together, with curative intent, and extensive disease SCLC (ED-SCLC), which is typically treated with chemo alone and is not considered conventionally curable.
Here's a situation in which I learned something from the questions raised by people here online. A handful of people with extensive disease small cell lung cancer (ED-SCLC) in the last year or two have mentioned receiving radiation for areas of residual apparent disease after receiving initial chemotherapy. I had noted that I had never done this and didn't really see a clear rationale for pursuing a local treatment like radiation for a disease that has already declared itself as spreading throughout the body.
As described in my last post, one of the interesting points we've seen from the recent trial of maintenance alimta vs. placebo after first line chemo for advanced NSCLC is that alimta's beneficial effects appear to be concentrated on the 2/3 of patients with non-squamous cancers, while the patients with squamous cell NSCLC did no better with alimta than with placebo.
While the differences in anticipated clinical benefits from EGFR tyrosine kinase inhibitors like tarceva and iressa are well known (summarized in prior post), less well appreciated is the potentially significant differences in results with garden variety standard chemotherapy.
Member Wendy asked me about a drug called picoplatin that I had heard of but really didn't have much familiarity with. This gave me an occasion to flesh out some background on this agent, which is being developed as a potential therapy for patients previously treated for lung cancer.
There's been several discussions about the potential value of maintenance therapy after the initial chemotherapy for SCLC; I've discussed this subject in a prior post, in which I focused on chemo -- while the results haven't been strong enough to lead to a change in standard practice, at least one trial showed a strong trend in the right direction.