Small Cell Lung Cancer Treatments

SCLC is usually divided into two types: limited-stage or extensive-stage. It’s classified as extensive-stage if it has spread:

• throughout your lung
• to your other lung
• to lymph nodes on the other side of your chest

About two-thirds of people have extensive-stage SCLC when they receive a diagnosis. Treatment for extensive-stage SCLC usually revolves around trying to extend your life and reduce symptoms.

Treatment for limited-stage SCLC often aims to cure the cancer.

Chemotherapy is used to treat limited- or extensive-stage SCLC, often in combination with other treatments. Chemotherapy drugs are usually given as an intravenous (IV) infusion or an injection. They’re sometimes administered through larger IVs called central venous catheters.

For limited-stage SCLC

Treatment for limited-stage SCLC may include:

• chemotherapy with or without radiation therapy to the chest
• chemotherapy after surgery with or without radiation therapy

For extensive-stage SCLC

Treatment for extensive-stage SCLC may include:

• chemotherapy with a type of immunotherapy called immune checkpoint inhibitors
• chemotherapy drugs alone

Doctors often administer a combination of chemotherapy drugs to target cancer cells in different ways. Some of the most common combinations in people with SCLC include:

• cisplatin and etoposide
• carboplatin and etoposide
• cisplatin and irinotecan
• carboplatin and irinotecan

Learn more about how chemotherapy is used to treat SCLC.

Immunotherapy medications stimulate your immune system to attack cancer cells. Doctors use a type of immunotherapy called immune checkpoint inhibitors to treat extensive-stage SCLC, often in combination with chemotherapy.

Immune checkpoint inhibitors work by blocking proteins made by cancer cells that allow them to hide from your immune cells. In the case of SCLC, doctors administer atezolizumab or durvalumab to block the protein PD-L1.

These drugs are usually given through an IV every 2–4 weeks.

Learn more about immunotherapy for lung cancer.

Radiation therapy is one of the most common treatments for SCLC. It involves aiming high energy rays at cancer cells to kill them. Doctors usually use external beam radiation therapy to treat lung cancer. This type of radiation therapy involves administering radiation from a machine outside of your body.

For limited-stage SCLC

Radiation therapy may be used to treat limited-stage SCLC:

• in combination with chemotherapy
• in combination with chemotherapy after surgery
• as cranial irradiation to prevent the spread to your brain

For extensive-stage SCLC

For extensive-stage disease, it may be administered:

• to your chest if you respond to chemotherapy
• to your brain, spine, bones, or other body parts as a palliative therapy
• to your brain if you had a complete response to other treatments

Radiation as an initial SCLC treatment is usually given 1–2 times daily, 5 days per week for 3–7 weeks, according to the American Cancer Society (ACS). Cranial irradiation is usually administered for fewer than 3 weeks, the ACS says.

Research from 2021 estimates that in 10–20% of people with SCLC, the cancer has spread (metastasized) to the brain by the time of diagnosis, while 50–80% eventually develop metastasis during treatment.

Research from 2020 supports that cranial irradiation reduces the chances of cancer spreading to the brain, but it’s less clear whether it improves survival.

Learn more about radiation therapy for lung cancer.

SCLC has usually spread too far to be treated surgically when it is diagnosed. Surgery may be used for limited-stage disease:

• before chemotherapy
• before chemotherapy in combination with radiation therapy

Surgery is usually performed under general anesthesia through a large incision in your back or chest. Doctors can use different types of surgery to treat lung cancer such as:

• Pneumonectomy: This is a procedure where your entire lung is removed.
• Lobectomy: This procedure to remove one of the lobes of your lung. Your right lung has three lobes and your left lung has two.
• Sleeve resection: This is a procedure to treat tumors in large airways. It involves cutting above and below the tumor and reattaching the two ends of your airway.
• Segmentectomy: This is a procedure to remove the part of a lobe that contains the tumor.

You may also have lymph nodes removed during any of these procedures.

Learn more about types of surgery for lung cancer.

Palliative procedures can help reduce your symptoms and increase your survival time. They don’t aim to cure the cancer.

Palliative procedures include:

• radiation therapy to treat cancer that has spread to distant body parts
• photodynamic therapy to improve your breathing, which involves injecting a light-activated drug into a vein
• laser therapy to open blocked airways
• stent placement to open up airways
• treatments for fluid buildup around your lungs such as:
  • thoracentesis
  • pleurodesis
  • catheter placement
• treatments for fluid buildup around the heart such as:
  • pericardiocentesis
  • pericardial window

Learn more about the final stages of lung cancer.

Researchers are continuing to examine new treatments for SCLC in clinical trials. These treatments will become the new standard treatments if researchers find they’re more effective than current options.

Some clinical trials currently underway include:

• examining whether brain scans alone are as effective as brain scans with cranial irradiation for improving survival
• examining whether the addition of radiation therapy to immune therapy improves survival of extensive-stage SCLC
• examining the potential benefit of adding the drug BAY 1895344 to usual chemotherapy for advanced solid tumors (in particular, SCLC tumors)
• examining the benefit of adding the immunotherapy drug atezolizumab to usual chemoradiation therapy
• examining the drug tazemetostat combined with topotecan and pembrolizumab for recurrent SCLC

Learn more about clinical trials for SCLC.

SCLC is an aggressive form of lung cancer. It has usually already spread beyond the lungs when it’s diagnosed.

Treatment for limited-stage SCLC often includes some combination of chemotherapy, surgery, and radiation therapy to try to cure the cancer.

Extensive-stage disease is usually treated with a combination of chemotherapy, radiation therapy, and immunotherapy.