Lung Cancer.pdf

11 CHEMOTHERAPY IN THE
TREATMENT OF
EXTENSIVE-STAGE SMALL
CELL LUNG CANCER
George R. Blumenschein, Jr.
Chapter Overview ....................................................................................... 207
Introduction ................................................................................................. 208
Staging and Initial Workup ....................................................................... 208
Prognostic Factors ....................................................................................... 209
Common Presenting Symptoms ............................................................... 209
Chemotherapy for Previously Untreated Disease .................................. 210
Development of the Current Approach to Treatment ...................... 210
Follow-up during Therapy ................................................................... 212
Outcomes ................................................................................................ 212
Duration of Therapy .............................................................................. 212
Alternating Chemotherapy Regimens ................................................ 214
Dose Intensification of Chemotherapy ............................................... 215
Chemotherapy for Refractory or Recurrent Disease .............................. 215
Palliation of Symptoms .............................................................................. 217
Future Directions ......................................................................................... 217
Key Practice Points ..................................................................................... 217
Suggested Readings .................................................................................... 218
Chapter Overview
Chemotherapy is the primary treatment modality for patients with extensive-stage
small cell lung cancer. In this group, chemotherapy has been
shown to not only improve quality of life through palliation of symptoms
but also improve median survival compared with the median survival of
patients who are treated with best supportive care. Eligible patients
should be offered treatment in clinical trials with chemotherapy-based
regimens. Patients who are not eligible for a clinical trial should be offered
etoposide and cisplatin given in 3-week cycles. Patients with extensivestage
small cell lung cancer that is refractory to first-line chemotherapy or