Treatments for small cell lung cancer

If you have small cell lung cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for small cell lung cancer, your healthcare team will consider:

• whether the cancer is limited stage or extensive stage
• your overall health
• your personal preferences (what you want)

You may be offered one or more of the following treatments for small cell lung cancer.

Small cell lung cancer often responds well to treatment with chemotherapy. It is most commonly treated with a combination of 2 drugs, which is more effective than one drug alone. The most common chemotherapy drug combinations used are:

• cisplatin and etoposide (Vepesid)

• carboplatin and etoposide

If you are in poor health, you may be given lower doses of chemotherapy as a treatment for small cell lung cancer.

If you are not able to or do not want to have combination chemotherapy, etoposide may be given by mouth as a pill.

Lurbinectedin (Zepzelca) may be offered for small cell lung cancer that doesn't respond to, or stops responding to, treatment with cisplatin.

Most people with small cell lung cancer have radiation therapy. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given.

External beam radiation therapy uses a machine to direct radiation at the lung tumour and the surrounding lymph nodes in the chest. There are several different types of external radiation therapy used for small cell lung cancer.

• 3D conformal radiation therapy (3D-CRT)

• intensity-modulated radiation therapy (IMRT)

• stereotactic body radiotherapy (SBRT)

• hypofractionated radiation therapy

Prophylactic cranial irradiation (PCI) is external beam radiation given to the whole brain. It may help prevent brain metastases and improve survival. It is used when small cell lung cancer has responded well to chemotherapy and radiation therapy. It is not offered with small cell lung cancer that has not responded to chemotherapy.

Chemotherapy is often combined with radiation therapy to treat limited stage small cell lung cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Chemoradiation is only offered if you are healthy enough to have both treatments at the same time.

Endobronchial therapies remove a blockage caused by the cancer inside the lung and help with symptoms, such as problems with breathing, pain or coughing up blood. They may also be used if you cannot have surgery or radiation therapy.

The type of endobronchial therapy used will depend on how quickly the symptoms must be treated.

Surgery may be used to diagnose and stage small cell lung cancer. But it is not used very often to treat small cell lung cancer because this type of cancer has usually spread to other parts of the body by the time it is diagnosed.

In rare cases, surgery may be part of a treatment plan for limited stage small cell lung cancer that was found as a nodule (spot) in your lung and that has not spread to the lymph nodes or outside the lung. You have to be healthy enough to have surgery. These types of surgery may be used for limited stage small cell lung cancer:

A lobectomy removes the lobe of the lung where the tumour is.

A segmental resection removes the tumour along with a margin of healthy tissue around the tumour.

During surgery for limited stage small cell lung cancer, the lymph nodes in the chest and around the lungs are removed and checked for cancer. If there is cancer in more lymph nodes than was shown with diagnostic tests, the surgery may be stopped because the cancer has spread too far for surgery to be helpful as a treatment.

Surgery isn't used to treat extensive stage small cell lung cancer because it has already spread to other parts of the body by the time it is diagnosed. Surgery may be used to remove a brain metastasis or a tumour that has spread to the adrenal gland.

Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. Atezolizumab (Tecentriq, Tecentriq SQ) may be used in combination with carboplatin and etoposide as the first treatment for extensive stage small cell lung cancer.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with small cell lung cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

To make the decisions that are right for you, ask your healthcare team questions about treatment.