Chemotherapy advances in small cell lung cancer

Small cell lung cancer accounts for 13-15% of all lung cancer worldwide. There has been a decrease in the number of cases, with no clear explanation, except probably to changing in smoking habits in the last two decades. In the early 1980s, it became clear that SCLC was an extremely sensitive tumour to radiation as it was to chemotherapeutic agents. With cisplatinum etoposide combinations or cyclophosphamide, anthracycline and vincristine/etyoposide regimens responses were observed in 50-70%, with 20-30% complete remissions in extensive disease. For limited-stage patients chemotherapy associated with thoracic radiation was able to produce a cure rate of 10-20%.The addition of prophylactic brain irradiation to limited stage cases has reduced mortality by a factor of nearly 5%. But despite these early good results no breakthrough came later on, and in the last decade or so, we are still facing this plateau. New agents have recently been included in the therapeutic armamentarium, such as gemcitabine, irinotecan, paclitaxel and more recently pemetrexed. This fact has allowed many patients to receive a relatively active second line therapy, but the overall survival remains unchanged. Targeted therapies are undergoing some evaluations, but the data are too premature and, so far, quite discouraging. At the present time there is an urgent need to improve clinical research in this somehow forgotten disease.