By Luis Raez, MD, Chief of Hematology/Oncology and Medical Director, Memorial Cancer Institute, Memorial Healthcare System
For decades, small cell lung cancer (SCLC) has had a notorious reputation. Not only is it an especially aggressive type of lung cancer, but one with limited treatment options for advanced stages of the disease—the stage at which nearly two-thirds of patients are diagnosed. Even the treatment of SCLC is characterized by a cruel paradox, in which patients typically respond well to traditional first-line chemotherapy) treatment, only to have a recurrence of their cancer within less than six months. And unfortunately, many of these patients typically do not respond well to second and third-line chemotherapy, all of which contribute to SCLC’s poor prognosis. It is devastating to see a patient’s tumor shrinking at the start of treatment and know that this is not likely to last. Often considered the “worst-case scenario” in lung cancer by patients and physicians alike, it fair to say that SCLC has earned its nasty reputation.
With this type of outlook, it is easy to become fixated on the pessimism that accompanies this diagnosis. And while it is important to be realistic with patients when it comes to prognosis and outcomes, that doesn’t mean that we should fall victim to this pessimism. Today, there are greater opportunities for patients to participate in clinical trials – far more than when I started treating this disease over 20 years ago. And treatment advancements such as immunotherapy, are offering new ways of battling this disease. Ongoing research, advances and drug approvals are offering us promising reasons to hope and serve as a reminder that we need to update our thinking about how we approach SCLC.
After more than 30 years of little-to-no advancement in SCLC, today both immunotherapy and immunotherapy plus chemotherapy are FDA-approved, recommended treatment options for SCLC. Immunotherapy plus chemotherapy is an option for first-line SCLC treatment, while immunotherapy alone is an option for later lines of treatment.
Our current gains against SCLC may seem small, but after decades of little to no advancement, it is progress nonetheless. We now have more first-line treatment options and for some patients the hope for more time. And for many of my patients and their loved ones, more time means everything in the world. With ongoing research and continued long-term follow-up, the hope is that these current gains are stepping stones to larger ones.
Here at Memorial Healthcare System, we are conducting research with independent partners to develop much-needed new therapies for SCLC. While we all dream of a future where cure is an anticipated outcome, it is important to recognize meaningful advances to take each day and fight one battle at a time. In the not too distant future, we hope to be able to offer treatment for SCLC that puts survival at five years or longer as we’re seeing with non-small cell lung cancer.
SCLC continues to be a difficult to treat cancer, but instead of giving in to the pessimism, I find myself optimistic for my patients and for the future. With new treatments, we can offer patients more options and more reasons to hope as we work toward the next discovery.