From the Guidelines
The standard chemotherapy regimen for small cell lung cancer (SCLC) is a platinum-based combination therapy, typically cisplatin or carboplatin with etoposide (EP regimen) 1. For limited-stage SCLC, this regimen is usually given for 4-6 cycles concurrent with radiation therapy, while for extensive-stage disease, 4-6 cycles are administered without concurrent radiation. The typical dosing is carboplatin AUC 5 on day 1 or cisplatin 100 mg/m² on day 1, with etoposide 120 mg/m² on days 1-3, repeated every 21 days, as recommended by the NCCN guidelines 1. For extensive-stage SCLC, the addition of immunotherapy (atezolizumab or durvalumab) to EP has become standard of care in the first-line setting. Second-line options for relapsed disease include topotecan, irinotecan, or temozolomide. This platinum-etoposide combination is effective because SCLC is initially chemosensitive due to its high proliferation rate and DNA repair deficiencies, though resistance often develops. Patients should be monitored for common side effects including myelosuppression, nausea, fatigue, and nephrotoxicity, with appropriate supportive care provided throughout treatment. Some key points to consider when administering this regimen include:
- The use of carboplatin instead of cisplatin may reduce the risk of emesis, neuropathy, and nephropathy, but increases the risk of myelosuppression 1.
- The substitution of carboplatin for cisplatin is more acceptable in patients with extensive-stage disease, as data show these drugs are equivalent in this setting 1.
- Other combinations, such as irinotecan and a platinum agent, have been evaluated, but the evidence is not consistent, and the EP regimen remains the standard of care 1. The most recent and highest quality study, published in 2021, supports the use of the EP regimen as the standard of care for SCLC 1.
From the FDA Drug Label
In small cell lung cancer, the Etoposide Injection, USP dose in combination with other approved chemotherapeutic drugs ranges from 35 mg/m 2/day for 4 days to 50 mg/m 2/day for 5 days. Topotecan is a topoisomerase inhibitor indicated for: small cell lung cancer sensitive disease after failure of first-line chemotherapy. Small cell lung cancer: 1.5 mg/m 2 by intravenous infusion over 30 minutes daily for 5 consecutive days, starting on day one of a 21-day course.
The chemotherapy regimen used for lung small cell lung cancer (SCLC) includes:
- Etoposide: 35 mg/m 2/day for 4 days to 50 mg/m 2/day for 5 days
- Topotecan: 1.5 mg/m 2 by intravenous infusion over 30 minutes daily for 5 consecutive days, starting on day one of a 21-day course 2 3
From the Research
Chemotherapy Regimens for Lung Small Cell Lung Cancer (SCLC)
- The standard chemotherapy regimen for SCLC includes a platinum agent such as cisplatin combined with the non-platinum agent etoposide 4.
- Platinum-etoposide is the most commonly used chemotherapy regimen for SCLC, but platinum-irinotecan can also be considered 4.
- For extensive-stage SCLC, combined chemotherapy with cisplatin plus etoposide plus irinotecan could be considered as a standard second-line chemotherapy for selected patients 5.
- In patients with limited-stage SCLC, cisplatin-etoposide plus radiotherapy should remain the standard therapy 4.
- For advanced or extensive-stage SCLC, combined chemotherapy (platinum-etoposide) and immunotherapy (atezolizumab or durvalumab during and after chemotherapy) has become the new standard front-line treatment 6.
Comparison of Chemotherapy Regimens
- A pooled analysis compared the efficacy and safety of cisplatin plus etoposide (EP) and carboplatin plus etoposide (EC) regimens in the first-line treatment of extensive-stage SCLC, and found that the EP regimen was independently associated with better progression-free survival (PFS) and overall survival (OS) among patients who were overweight and obese 7.
- The EC regimen was associated with a higher risk of grade 3-4 neutropaenia, thrombocytopaenia, and hyponatraemia, whereas the EP regimen was associated with a higher risk of grade 3-4 vomiting 7.