Treatment for extensive stage small cell lung cancer (SCLC) usually involves combination treatment. It may be a combination of chemotherapy drugs or chemotherapy plus immunotherapy.

Let’s take a closer look at combination therapy for extensive stage SCLC, how it works, and things to consider before choosing a treatment.

While surgery and radiation to the chest are used for limited stage SCLC, they’re not typically used for extensive stage. The first-line treatment for extensive stage SCLC is combination chemotherapy.

There are several goals of chemotherapy. It can shrink tumors, lessen symptoms, and slow disease progression. This is important in treating SCLC because it’s a particularly fast-growing cancer. These powerful drugs can stop cancer cells from growing and reproducing.

Chemotherapy drugs don’t target a specific tumor or a specific part of the body. It’s a systemic treatment. That means it seeks out cancer cells wherever they are.

Combination chemotherapy may include:

  • etoposide plus cisplatin
  • etoposide plus carboplatin
  • irinotecan plus cisplatin
  • irinotecan plus carboplatin

Chemotherapy is typically given by infusion on a set schedule. Before you start, your doctor will assess your overall health to make sure you’re able to withstand the side effects of treatment.

Cancer cells are masters of disguise. They can fool your immune system into not seeing them as dangerous.

Immunotherapy, also known as biologic therapy, provides a boost to the immune system. It helps it recognize and attack cancer cells. Unlike chemotherapy, it doesn’t cause harm to healthy cells.

The immunotherapy drug atezolizumab (Tecentriq) can be given along with combination chemotherapy. Once you’re finished with chemotherapy, you can stay on atezolizumab as a maintenance therapy.

Other immunotherapy drugs that might be used for SCLC are:

  • ipilimumab (Yervoy)
  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)

Immunotherapy is typically given by intravenous (IV) infusion on a regular schedule.

Combination chemotherapy for extensive stage SCLC can slow disease progression and provide some relief from symptoms. It has an initial response rate of 60 to 80 percent. In some cases, the response is so dramatic that imaging tests can no longer detect the cancer.

This is usually temporary, though. Extensive stage SCLC almost always recurs, sometimes within months. After recurrence, the cancer may be resistant to chemotherapy.

For this reason, your doctor may recommend continuing with immunotherapy after finishing chemotherapy. Your doctor may also suggest radiation treatment to the brain. This can help prevent the cancer from spreading to your brain.

Clinical trials of immunotherapy for SCLC have had mixed results. One recent trial looked at atezolizumab with platinum-based chemotherapy. When compared to chemotherapy alone, there was significant improvement in overall survival and progression-free survival.

Immunotherapy for the treatment of extensive stage SCLC is promising but still relatively new. Clinical trials studying immunotherapy with combination chemotherapy are ongoing.

If the cancer doesn’t go into remission or continues to spread, you’ll need further treatment. Your choices will depend on where it has spread and which therapies you’ve already tried.

Cancer involves rapidly dividing cells. Chemotherapy drugs target cells that divide quickly. That means they also affect some healthy cells. This is what causes so many of the side effects associated with this treatment.

Side effects of chemotherapy vary based on the particular drugs, dosage, and how often you get it. Everyone reacts differently. The list of potential side effects is long, but you probably won’t experience all of them. Side effects may include:

  • fatigue
  • weakness
  • nausea
  • vomiting
  • loss of appetite
  • diarrhea
  • hair loss
  • weight loss
  • brittle nails
  • bleeding gums
  • increased risk of infection

Immunotherapy may cause:

  • nausea
  • fatigue
  • joint pain
  • diarrhea or constipation
  • flu-like symptoms
  • changes in weight
  • loss of appetite

Symptoms of an infusion reaction can cause:

  • fever, chills, or flushing of the face
  • rash
  • itchy skin
  • dizziness
  • wheezing
  • trouble breathing

Radiation therapy can lead to:

  • fatigue
  • loss of appetite
  • skin irritation similar to sunburn
  • scalp irritation
  • hair loss

Many side effects can be managed with other therapies or lifestyle modifications. Be sure to tell your healthcare team when you have side effects.

Before choosing a treatment, your doctor will evaluate your overall health. In some cases, the side effects of standard treatments may be too harsh. Together, you can decide if you should have lower doses of chemotherapy, immunotherapy, or palliative care alone. You can also talk to your doctor about possibly enrolling in a clinical trial.

Palliative care is also known as supportive care. It won’t treat your cancer, but it can help manage the individual symptoms and restore your quality of life for as long as possible. You can receive palliative care along with combination therapy.

Whether it’s before, during, or after treatment, you’re bound to have questions and concerns. Your healthcare team is there to help. They want your treatment to go as smoothly as possible and can lend support where needed. When necessary, they can refer you to others who may be of assistance.

The first-line therapy for extensive stage SCLC is combination therapy. This can mean a combination of chemo drugs alone or together with immunotherapy. But treatment must be tailored to your specific needs.

Open communication with your doctor is the best way to make sure you’re on the same page. Together, you can make the choices that are best for you.