Tables
- Table 1 Paraneoplastic syndromes associated with lung cancer [5, 6]
Syndrome Patients affected % Causative protein or antibody Hyponatraemia/SIADH 15 Arginine vasopressin or atrial natriuretic peptide Ectopic corticotropin syndrome 2–5 Corticotropin Lambert–Eaton myasthenic syndrome 3 Voltage-gated calcium channel antibody Acromegaly <1 GHRH Gynaecomastia <1 Hypercoagulability <1 Thrombocytosis <1 Encephalomyelitis/subacute sensory neuropathy <1 Anti-Hu, amphiphysin, CV2 Cancer-associated retinopathy <1 Anti-recoverin Dermatomyositis <1 Acanthosis palmaris, erythema gyratum repens <1 Nephrotic syndrome <1 SIADH: syndrome of inadequate antidiuretic hormone; GHRH: growth hormone-releasing hormone.
- Table 2 Small cell lung cancer: survival according to extent of disease at presentation [11] modified by therapy [12]
LD: tumour limited to one potential irradiation field ED: not confined to one hemithorax, malignant pleural effusion or distant metastases Median survival of all patients 16–24 months 6–12 months 5-year survival of all patients 14% Rare Supportive care 3 months 1.5 months Single-agent chemotherapy 6 months 4 months Combined chemotherapy 10–14 months 7–11 months 5-year survival 2–8% 0–1% Chemotherapy plus radiation 12–16 months 7–11 months 5-year survival 6–12% 0–1% LD: limited disease; ED: extensive disease.
- Table 3 TNM staging of lung cancer [15]
Occult carcinoma Tx N0 M0 Stage 0 Tis Stage IA T1a–T1b N0 M0 Stage IB T2a N0 M0 Stage IIA T1a–T2a N1 M0 T2b N0 M0 Stage IIB T2b N1 M0 T3 N0 M0 Stage IIIA T1a–T3 N2 M0 T3 N1 M0 T4 N0–N1 M0 Stage IIIB T4 N2 M0 T1a–T4 N3 M0 Stage IV Any T Any N M1a or M1b - Table 4 WHO/IASLC Subtypes of neuroendocrine tumours [20]
Subtype Characteristics Classical SCLC Small round, oval or spindle-shaped cells with scant cytoplasm, ill-defined borders, finely granular nuclear chromatin and absent or inconspicuous nucleoli. High mitotic count. Characteristic crush phenomena due to the soft texture of the tumour and mechanical alterations. Histomorphological grading G1 to G4 not applicable. Typical/atypical carcinoid Usually less aggressive tumour. Large cell neuroendocrine tumour Proliferation index relevant for classification. Combined SCLC Small-cell carcinoma with an additional component of any of the histological types of NSCLC WHO: World Health Organization; IASLC: International Association for the Study of Lung Cancer; SCLC: small cell lung cancer; NSCLC: non-small cell lung cancer.
- Table 5 Some genetic alterations in small cell lung cancer (SCLC) [23, 24]
Gene (locus) Alteration Possible drug/therapeutic targeting abnormalities FHIT (3p14.2) Loss (80% of SCLC) RASSF1 (3p21.3) Loss (>90% of SCLC) RARB (3p24) Loss (72% of SCLC) TP53 (17p13.1) Mutation and deletion (>75% of SCLC) p53 adenoviral vector (Advexin) c-Kit Overexpressed Tyrosine kinase inhibitor (imatinib) Src Constitutively activated Src inhibitor (dasatinib) c-Met Amplified, overexpressed or mutated siRNA, c-Met inhibitor SU11274 RB1 Altered (>90% of SCLC) PI3K/Akt/mTOR Constitutively activated PI3K inhibitor (LY294002) mTOR inhibitor (rapamycin) and its derivatives (CCI-779, RAD001, AP23576) Bcl-2 Overexpressed Antisense oligonucleotide (oblimersen sodium) Inhibitor of Bcl-2 (ABT-737) VEGF Overexpressed Humanised monoclonal antibody (bevacizumab) VEGFR-2 and EGFR inhibitor (ZD6474) FHIT: fragile histidine triad; RASSF: Ras-association domain family; RARB: retinoic acid receptor-β; TP53: tumour protein p53; RB: retinoblastoma; PI3K: phosphoinositide 3-kinase; mTOR: mammalian target of rapamycin; Bcl: B-cell lymphoma; VEGF: vascular endothelial growth factor; siRNA: small interfering RNA; EGFR: epidermal growth factor.
- Table 6 Widely used chemotherapeutic regimens with effect against small cell lung cancer [6]
Regimen Dosage Application Cycles/Precautions CisEto Every 3 weeks, or after nadir, normal renal function and diuretics are mandatory Cisplatin 80 mg·m−2 i.v. d1 Etoposide 100 mg·m−2 i.v. d1–d3 ACO-I after Livingston and Seeber Every 3 weeks; vincristine dosage has to be adjusted to age; >60 years reduce to 1 mg·m−2 Adriamycin 60 mg·m−2 i.v. d1 Cyclophosphamide 750 mg·m−2 i.v. d1 Vincristine 2 mg·m−2 i.v. d1/d8/d16 ACE combination after Klastersky Adriamycin 45 mg·m−2 i.v. d1 Cyclophosphamide 1000 mg·m−2 i.v. d1 Etoposide 80 mg·m−2 i.v. d1–d3 Every 3 weeks. EpiCO therapy after Drings Every 3 weeks; vincristine dosage has to be adjusted to age; >60 years reduce to 1 mg·m−2 Epirubicin 70 mg·m−2 i.v. d1 Cyclophosphamide 1000 mg·m−2 i.v. d1 Vincristine 2 mg·m−2 i.v. d1/d8/d16 Carboplatin/etoposide Every 3 weeks, or after nadir, normal renal function and diuretics are mandatory Carboplatin AUC 5 i.v. d1 Etoposide 100 mg·m−2 i.v. d1-d3 Paclitaxel/etoposide/carboplatin Every 3 weeks, steroids to prevent anaphylactic crisis after administration of paclitaxel is mandatory Paclitaxel 175 mg·m−2 i.v. for 3 h Carboplatin AUC 5 d4 Etoposide I–III: 100 mg·m−2 i.v. d4 IV: 100 mg·m−2 d1–d3 Cisplatin/irinotecan Atropine 0.25 mg 1/2 h before irinotecan s.c. Every 4 weeks and/or after nadir; diarrhoea is common Cisplatin 60 mg·m−2 i.v. d1 Irinotecan 60 mg·m−2 i.v. d 1, 8,15 Topotecan (second-line) Topotecan 1.25 mg·m−2 with subsequent dose adjustment according to haematological toxicity i.v. d 1–5 Every 3 weeks and/or after reaching normal laboratory values - Table 7 Small cell lung cancer: response to newer agents [6, 34–38]
Agent Response rate (%) Paclitaxel 34–41 Irinotecan 47# Topotecan 39 Docetaxel 28# Gemcitabine 26 Vinorelbine 12.5# Bendamustine 72.7% first-line in combination with carboplatin Amrubicin 21.3# (refractory patients), 44# (sensitive patients) #: previously treated patients only.
- Table 8 Treatment of brain metastases by radiotherapy modified from [32]
First author [ref.] Patients n CR+PR % CR % Median survival months (range) Nugent [39] 68 92 3 Cox [40] 40 75 38 4 (0–21) Baglan [41] 47 85 64 4 Hirsch [42] 45 46 Lucas [43] 39 56 25 (1–28) Carmichael [44] 61 63 32 7 (1–18) Gianonne [37] 41 85 70 11 (1–24) CR: complete response; PR: partial respose.
Vol 8 Issue 4
Table of Contents
Update on small cell lung cancer management
