What is the prognosis for a patient with stage 4 (four) small cell lung cancer (SCLC)?

From the Guidelines

Stage 4 small cell lung cancer has a poor prognosis, with a median survival of 6-12 months with treatment, as reported in the most recent guideline by the American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) 1. The five-year survival rate is approximately 3% and treatment typically involves combination chemotherapy with etoposide plus either cisplatin or carboplatin, which can extend life and improve symptoms. Some key points to consider in the management of stage 4 small cell lung cancer include:

• The importance of smoking cessation, as it can improve outcomes in patients with lung cancer 1
• The role of immunotherapy drugs like atezolizumab or durvalumab, which may be added to chemotherapy in some cases
• The use of radiation therapy for symptom relief or to treat brain metastases
• The need for patients to discuss palliative care options early to manage symptoms and improve quality of life alongside cancer treatment The poor prognosis is due to the aggressive nature of small cell lung cancer and the fact that by stage 4, it has already spread to distant organs like the brain, liver, or bones. Age, overall health, extent of disease spread, and response to treatment all influence individual prognosis. According to the guideline, any discussion of the management of patients with SCLC would be incomplete without a strong recommendation for smoking cessation, not only to decrease the risk of developing lung cancer, but also to improve the outcomes of people already diagnosed with lung cancer 1. Additionally, the guideline highlights the importance of considering the patient's quality of life and symptoms when making treatment decisions, and notes that palliative care should be integrated into the treatment plan from the outset. In terms of specific treatment options, the guideline recommends combination chemotherapy with etoposide plus either cisplatin or carboplatin as the standard of care for patients with extensive-stage SCLC, and notes that immunotherapy drugs like atezolizumab or durvalumab may be added to chemotherapy in some cases 1. Overall, the management of stage 4 small cell lung cancer requires a comprehensive and multidisciplinary approach that takes into account the patient's individual needs and circumstances.

From the Research

Stage 4 Small Cell Lung Cancer Prognosis

• The prognosis for stage 4 small cell lung cancer is generally poor, with a median overall survival (OS) of 12.5 months 2 and 14.0 months 3.
• The 5-year survival rates for stage 4 small cell lung cancer are around 14% 2 and 21.7% for 2-year OS rates 3.
• Several factors can affect the prognosis of stage 4 small cell lung cancer, including:
  • Demographic characters: age ≥ 70, smoking index ≥ 400 3
  • Tumor burden factor: bone multimetastasis 3
  • Tumor biomarkers: cyfra211, CA125 3
  • Laboratory indexes: decreased Na, PLR < 76 3
• Treatment options for stage 4 small cell lung cancer include chemotherapy, such as etoposide plus cisplatin 4, 5, and immunotherapy 6.
• The choice of treatment and prognosis can depend on various factors, including the patient's overall health, tumor characteristics, and response to treatment.
• Studies have shown that increasing doses of etoposide can result in increased complete response rates, but have no impact on overall response rates or survival 5.
• Etoposide plus platinum has been shown to have better clinical application value for small cell lung cancer, with equivalent efficacy and safer than other regimens 4.