From the Guidelines
The standard chemotherapy regimen for small cell lung cancer (SCLC) treated with concurrent chemoradiation therapy is cisplatin plus etoposide. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as outcomes 1.
- Typically, patients receive 4-6 cycles of chemotherapy, with cisplatin administered at 60-80 mg/m² on day 1 and etoposide at 80-120 mg/m² on days 1-3 of each 21-day cycle.
- The first 1-2 cycles are usually given concurrently with radiation therapy, followed by the remaining cycles as consolidation therapy.
- For patients who cannot tolerate cisplatin due to renal impairment or other contraindications, carboplatin (AUC 5-6) can be substituted, as supported by studies such as 1 and 1.
- Radiation therapy is typically delivered at a dose of 45-70 Gy over 3-7 weeks, depending on disease extent and patient factors.
- This regimen has been established as the standard of care because SCLC is highly sensitive to both chemotherapy and radiation, and the combination provides synergistic effects, as noted in 1, 1, and 1.
- The platinum agent damages DNA through cross-linking, while etoposide inhibits topoisomerase II, preventing DNA repair.
- Together, they enhance radiation-induced cell death, improving local control and survival outcomes compared to sequential therapy or radiation alone, which is consistent with the findings of 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. The chemotherapy regimen used in small cell lung cancer (SCLC) treated with chemoradiation therapy (CRT) includes etoposide.
- The dose of etoposide ranges from 35 mg/m 2/day for 4 days to 50 mg/m 2/day for 5 days. 2
From the Research
Chemotherapy Regimens Used in SCLC CRT
- The chemotherapy regimen commonly used in small cell lung cancer (SCLC) treated with chemoradiation therapy (CRT) includes a platinum agent combined with etoposide 3, 4, 5, 6.
- Cisplatin is the preferred platinum agent in the curative intent setting, whereas carboplatin is often used due to its favorable toxicity profile 3, 6.
- Studies have shown that both cisplatin and carboplatin can be used in combination with etoposide and radiation, with similar survival outcomes in patients with limited-stage SCLC 3, 5, 6.
Comparison of Cisplatin and Carboplatin
- A study comparing cisplatin and carboplatin in patients with limited-stage SCLC found no significant difference in overall survival (OS) or cause-specific survival (CSS) between the two groups 5.
- Another study found that cisplatin was not associated with a survival advantage over carboplatin in patients with either extensive-stage SCLC or limited-stage SCLC, irrespective of performance status and age 6.
- The choice between cisplatin and carboplatin may depend on individual patient factors, such as comorbidities and performance status 3, 6.
Other Chemotherapy Options
- Platinum-irinotecan is another chemotherapy regimen that can be considered for patients with SCLC, particularly those with extensive-stage disease 4.
- Topotecan and lurbinectedin are options for second-line treatment in patients with relapsed SCLC 7.
- Immunotherapy, such as atezolizumab or durvalumab, has become a standard front-line treatment for advanced or extensive stage SCLC, in combination with chemotherapy 7.