Overview of treatment options for small cell lung cancer

There are different types of treatment options for patients who have small cell lung cancer.

There are different types of treatment options available for patients with small cell lung cancer. Some treatments are standard approaches (therapies currently in use), and others are in clinical trials. A clinical trial of a treatment is a study designed to help improve an existing treatment or to get information about a new treatment for people with cancer. When a clinical trial shows that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may consider participating in a clinical trial. Some clinical trials are only open to patients who have not started treatment.

Six standard treatments are currently being used:

Surgery

Surgery may be used if the cancer is found in only one lung or and adjacent lymph nodes. Because this type of lung cancer is usually found in both lungs, surgical treatment alone is not often used. During surgery, the surgeon will also remove the lymph nodes to check for cancer cells inside. Surgery is also sometimes used to obtain a sample of lung tissue to determine the specific type of lung cancer.

After the surgeon removes all the cancer lesions that can be seen during surgery, some patients may receive chemotherapy or radiation therapy after surgery to kill any cancer cells that may remain. The treatment given after surgery to reduce the risk of the cancer coming back is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, kill them, or stop them from dividing. Chemotherapy drugs can be given orally, intravenously, or intramuscularly, into the bloodstream, and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy drugs are given directly into the cerebrospinal fluid, organs, or body cavities (such as the abdominal cavity), the drugs primarily affect cancer cells in these areas (local chemotherapy). The type of chemotherapy used depends on the type of cancer being treated and the stage of the cancer.

For more information, see Drug approval for small cell lung cancer.

Radiotherapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy:

Ex-vivo radiation therapy uses a machine outside the body to send radiation to the cancer site.

In vivo radiation therapy seals a radioactive substance in a needle, seed, wire, or catheter and places it directly in or near the cancer site.

The type of radiation therapy depends on the staging and staging of the cancer. External radiation therapy is used to treat small cell lung cancer and as palliative treatment to reduce symptoms and improve quality of life. Radiation therapy to the brain may also be given to reduce the risk of cancer spreading to the brain.

Immunotherapy

Immunotherapy is a therapy that uses the patient’s immune system to fight cancer. Substances produced by the body or prepared in the laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also known as biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy:

Immune checkpoint inhibitor therapy:Certain types of immune cells, such as T cells, and some cancer cells have certain proteins on their surface, called checkpoint proteins, that control the immune response. When cancer cells have large amounts of these proteins, they are not attacked and killed by T cells. Immune checkpoint inhibitors block these proteins and thus increase the ability of T cells to kill cancer cells. They are used to treat some patients with advanced small cell lung cancer.

There are two types of immune checkpoint inhibitor therapy:

CTLA-4 inhibitors:CTLA-4 is a protein on the surface of T cells that helps control the body’s immune response. When CTLA-4 binds to another protein on cancer cells called B7, it prevents T cells from killing cancer cells.CTLA-4 inhibitors bind to CTLA-4 and allow T cells to kill cancer cells. Ipilimumab is a CTLA-4 inhibitor.

Immune checkpoint inhibitor; the panel on the left shows the binding of the T-cell receptor (TCR) to antigen and MHC proteins on the antigen- presenting cell (APC) and the binding of CD28 on the T cell to B7-1/B7-2 on the APC. The panel on the right shows immune checkpoint inhibitor (anti-CTLA antibody) blocking the binding of B7-1/B7-2 to CTLA-4, which allows the T cells in the inactive state. -4, which allows the T cells to be active and to kill tumor cells.

Immune checkpoint inhibitor. Checkpoint proteins, such as B7-1/B7-2 on antigen-presenting cells (APCs) and CTLA-4 on T cells, help control the body’s immune response. T cells are activated when the T cell receptor (TCR) binds to antigen and major histocompatibility complex (MHC) proteins on APCs and CD28 binds to B7-1/B7-2 on APCs. However, the binding of B7-1/B7-2 to CTLA-4 leaves T cells in an inactivated state, so they cannot kill tumor cells in vivo (left panel). Blocking the binding of B7-1/B7-2 to CTLA-4 with an immune checkpoint inhibitor (anti-CTLA-4 antibody) activates the T cells and kills the tumor cells (right panel).

PD-1 inhibitors:PD-1 is a protein that sits on the surface of T cells and helps control the body’s immune response. When PD-1 binds to another protein on cancer cells called PDL-1, it prevents T cells from killing cancer cells. PD-1 inhibitors bind to PDL-1, causing T cells to kill cancer cells. Pembrolizumab and nabumab are two PD-1 inhibitors. Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells.

Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells.

Immune checkpoint inhibitors. Checkpoint proteins such as PD-L1 on tumor cells and PD-1 on T cells help suppress the immune response. the binding of PD-L1 to PD-1 prevents T cells from killing tumor cells in the body (left). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows T cells to kill tumor cells (right).

Immunotherapy uses the body’s immune system to fight cancer. This animation explains an immunotherapy treatment that uses immune checkpoint inhibitors to treat cancer.

For more information, see Drug approval for small cell lung cancer.

Laser therapy

Laser therapy uses a laser beam (a narrow beam of intense light) to kill cancer cells.

Endoscopic stent placement

An endoscope is a thin, tube-like instrument that is used to look at the tissues inside the body. The endoscope has a light source and a lens for observation, and may be used to place a stent inside a body structure to keep the structure open. Endoscopic stents may also be used to open airways that are blocked by abnormal tissue.

The novel therapy is in the testing phase of a clinical trial.

Information about clinical trials is available from the NCI website.

Treatment for small cell lung cancer may cause side effects.

For information about side effects of cancer treatment, see our side effects page.

Patients may want to consider enrolling in a clinical trial.

For some patients, participating in a clinical trial may be the best treatment option. Clinical trials are part of the cancer research process. The purpose of a clinical trial is to determine if a new therapy is safe and effective or better than standard therapy.

Many of the standard therapies now available are based on the results of previous clinical trials. Patients who participate in clinical trials may receive the standard treatment or they may be the first to receive the new therapy.

Patients who participate in clinical trials can also help improve the way cancer is treated in the future. Even if an effective new treatment is not studied, clinical trials often address important questions and advance research.

Patients can enter a clinical trial before, during, or after starting cancer treatment.

Some clinical trials allow only untreated patients to participate. Some trials are for patients with cancer that has not improved. Still other clinical trials are designed to study new measures to prevent the cancer from coming back (reoccurring) or to reduce the side effects of cancer treatment.

Clinical trials are being conducted in many parts of the country. Information about NCI-supported clinical trials can be found on the NCI’s Clinical Trials Search website. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed

Confirming a diagnosis of cancer or determining its stage may require repeat tests. Multiple tests should also be performed to determine the effectiveness of treatment. The results of these tests will determine if treatment needs to be continued, or if the treatment plan needs to be changed.

There are ongoing tests that will be done after treatment ends. The results of these tests can show whether your health has changed or whether the cancer has come back (recurred). These tests are called follow-up tests or rechecks.