Hèléne Nagy-Mignotte, PhD, of the University of Grenoble, France, and colleagues found that salvage chemotherapy may be ineffective in recurrent small cell lung cancer (SCLC), depending in large part on how well patients respond to first-line chemotherapy. The study was published in the July 16 online edition of the journal Lung Cancer. We have known for a long time that there is often only 1 chance of cure for SCLC, and that is with first-line therapy,” the researchers noted. If first-line therapy fails, it is imperative to consider the initial prognostic factors, as well as the timing and nature of the patient’s response to first-line therapy.” The investigators retrospectively analyzed data from 300 SCLC patients who received at least first-line chemotherapy. These patients were divided into three groups based on response to first-line therapy: sensitive, resistant and refractory. “We were thus able to determine whether the prognostic factors at diagnosis were good or bad, which in turn made it easier to decide which patients should be recommended for palliative care only and avoid ineffective aggressive treatment.” At the end of first-line chemotherapy, 47.7 percent of patients were sensitive, 24 percent were resistant, and 21.3 percent were refractory. The results showed that the objective response rate decreased from 73% at first-line chemotherapy to 38.1% at second-line chemotherapy and only 19.2% and 18.5% at third- and fourth-line chemotherapy, respectively. The complete response rate decreased from 31.3% with first-line chemotherapy to 2.5% with third-line chemotherapy (0 with fourth-line chemotherapy). Median survival was shortened from 13 months after first-line chemotherapy to 7.4 months after second-line chemotherapy, 5.1 months after third-line chemotherapy, and only 3.6 months after fourth-line chemotherapy. Based on these results, the investigators concluded that fourth-line chemotherapy is not meaningful for “sensitive” patients, third-line chemotherapy is not meaningful for “resistant” patients, and “refractory” patients do not need to receive Second-line chemotherapy is not necessary for “refractory” patients, with the exception of a few patients selected by a multidisciplinary consultation. Dr. Rebecca Suk Heist of the Massachusetts General Hospital Cancer Center agrees with this conclusion. He notes, “Clinical trials should take into account the reality of poor survival rates and lack of effective therapies for SCLC patients receiving chemotherapy. If a patient is too ill to receive standard chemotherapy or participate in a clinical trial, then he or she should be given the best supportive care and end-of-life care.