Lung Cancer - Small Cell: Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2021

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with SCLC. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for SCLC. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How small cell lung cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Chemotherapy is the primary treatment for SCLC. Additional treatment depends on whether or not it is limited stage SCLC or extensive stage SCLC (see Stages). For limited stage SCLC, chemotherapy is often combined with radiation therapy to the chest. For extensive stage SCLC, chemotherapy is often combined with immunotherapy. Radiation therapy can also be an option for people with extensive stage SCLC that could spread to the brain or has already spread to the brain. Surgery is not usually an option for people with SCLC, except for in a small number of people with very limited stage SCLC. These treatments are described below, followed by an outline of treatment options by stage. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for SCLC because there are different treatment options. Learn more about making treatment decisions.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for SCLC include:

  • Chemotherapy

  • Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes radiation therapy and/or surgery.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the primary treatment for SCLC because of how quickly the disease can spread. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.

Treatment can depend on if the disease is considered limited stage SCLC or extensive stage SCLC. For people with limited stage SCLC, chemotherapy plus radiation therapy (see Radiation Therapy section, below) to the chest is given daily over several weeks. People with extensive stage SCLC initially receive chemotherapy for 3 to 4 months. People with extensive stage SCLC initially receive a combination of chemotherapy and immunotherapy for 3 to 4 months, then remain on maintenance immunotherapy (see Immunotherapy section, below).

Usually, SCLC is treated with a combination of chemotherapy drugs:

  • Etoposide (available as a generic drug) and cisplatin (available a a generic drug)

  • Etoposide and carboplatin (available as a generic drug)

  • Irinotecan (Camptosar) and cisplatin

  • Irinotecan (Camptosar) and carboplatin

For people with SCLC that has spread after receiving previous platinum-based chemotherapy treatment, the FDA has also approved the chemotherapy drug lurbinectedin (Zepzelca).

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, loss of appetite, diarrhea, and hair loss. Nausea and vomiting are often avoidable. Learn more about preventing nausea and vomiting caused by cancer treatment. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. For example, the PD-1 pathway may be very important in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of SCLC for some patients. The following types of immunotherapy may be used for SCLC:

  • Atezolizumab (Tecentriq)

  • Durvalumab (Imfinzi)

  • Nivolumab (Opdivo)

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Radiation therapy

Radiation therapy is the use of high energy x-rays to destroy cancer cells. A radiation oncologist is a doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to 6 or more weeks.

Radiation therapy can be used to treat SCLC, prevent the spread of SCLC to the brain, and it can be used to relieve symptoms. For people with limited stage SCLC, radiation therapy directed to the cancer in the chest is recommended. For people who are receiving radiation therapy combined with chemotherapy (see above), radiation therapy to the chest should begin with the first or second cycle of chemotherapy. Radiation treatments may be given once or twice a day. Radiation therapy may also be recommended after surgery for patients who have residual disease or whose lymph nodes are involved with cancer. If chemotherapy shrank the cancer, then the remaining tumors and lymph nodes affected by cancer should receive additional treatment with radiation therapy.

For people who have stage I or stage II SCLC that has not spread to the lymph nodes and who cannot be treated with surgery, radiation therapy is recommended. A specific type of radiation therapy called stereotactic body radiation therapy (SBRT) may be an option. In SBRT, a large, precise radiation therapy dose is delivered to a small tumor area. For certain patients, SBRT may be followed by chemotherapy.

People with extensive stage SCLC often receive radiation therapy to treat remaining disease in the chest if chemotherapy has worked to shrink the cancer in other areas of the body. The radiation therapy should be given after chemotherapy treatment has finished. If extensive stage SCLC is being effectively treated with chemotherapy plus immunotherapy, radiation therapy may be given after chemotherapy is done but before maintenance immunotherapy starts.

In people whose cancer has shrunk during treatment, radiation therapy to the brain lessens the risk that the cancer will spread to the brain. This is called prophylactic cranial irradiation (PCI), and it has been shown to lengthen the lives of some patients. If the cancer responds to initial treatment, a repeat brain MRI scan after completion of chemotherapy is recommended (see Diagnosis). This will help guide decisions around whether PCI should be included in the treatment plan moving forward.

PCI may be a part of the treatment plan and the risks and benefits of the treatment should be discussed with the health care team. Generally, people with stage I SCLC should not receive PCI. People older than age 70 and people with other health conditions should discuss with their physician whether PCI would be beneficial in their case. Sometimes, using regular brain MRI scans to watch for cancer that may spread to the brain may be an alternative to PCI, particularly if chemotherapy has been effective.

This information is based on an ASCO guideline endorsement of an American Society of Radiation Oncology (ASTRO) clinical practice guideline, “Radiation Therapy for Small Cell Lung Cancer.” Please note that this link takes you to another website.

Side effects of radiation therapy

People with SCLC who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, patients may also develop a sore throat and have difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone (Rayos) and extra oxygen to help them breath. Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. Typically, the scarring does not cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation (see above).

Learn more about the basics of radiation therapy.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For lung cancer, a thoracic surgeon is specially trained to perform lung cancer surgery.

Surgery is rarely used for patients with SCLC and is only considered for people with very early-stage disease, such as cancer in a small lung nodule. In those situations, chemotherapy, with or without radiation therapy, is given after surgery (see above).

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

The following treatments may be given to help relieve the symptoms of SCLC:

  • Radiation therapy can be used to shrink a tumor in the chest that is bleeding or blocking the lung passages .

  • Using a bronchoscopy (See Diagnosis), lung passages blocked by cancer can be opened to improve breathing.

  • A surgeon can use a laser to burn away a tumor or place a stent to prop open an airway.

  • Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer. Learn more about managing cancer pain.

  • Medications can be used to suppress cough, open closed airways, or reduce bronchial secretions.

  • Prednisone or methylprednisolone (multiple brand names) can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.

  • Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to pull oxygen from the air.

  • Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases.

  • Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Treatment options by stage

For limited stage cancer, treatment may include chemotherapy combined with radiation therapy to try to cure the cancer. For extensive stage, using only systemic medications is likely a better option. Learn more about recommendations for the treatment of SCLC on a separate ASCO website.

Metastatic lung cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Most patients who develop metastatic SCLC need to start treatment right away. Talk with your doctor about the available treatment options, including clinical trials, so you are comfortable with the treatment plan.

Your treatment plan may include surgery, chemotherapy, immunotherapy, and/or radiation therapy. Chemotherapy is not as effective as radiation therapy or surgery to treat lung cancer that has spread to the brain. For this reason, lung cancer that has spread to the brain is usually treated with radiation therapy. Most people with brain metastases from lung cancer receive radiation therapy to the entire brain. This can cause side effects such as hair loss, fatigue, and redness of the scalp.

Palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called relapsed or recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When there is a recurrence, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as chemotherapy and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Treatment for recurrent SCLC may not work well for very long. If treatment does stop working, it is important to talk with your doctor about the next steps and the goals of further treatment.

People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Recovery from SCLC is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.