Small Cell Lung Cancer Treatment Protocols 

Updated: Feb 29, 2016
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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Treatment Protocols

Treatment protocols for small cell lung cancer (SCLC) are provided below, including first-line therapy, therapy for limited-stage disease, and therapy for extensive-stage disease.

Treatment recommendations for limited-stage SCLC

Stages I-III disease:

  • Limited-stage disease is typically treated with a combination of chemotherapy and radiation (concurrently) [1]
  • Sequential therapy can also be given for limited-stage disease for patients unable to tolerate concurrent chemoradiation; chemotherapy is given first, followed by radiation therapy because of the high rate of responsiveness to chemotherapy for SCLC [2, 1]
  • T3-4 tumors due to multiple ipsilateral lung nodules are treated as extensive-stage disease [1]

Concurrent chemotherapy recommendationswith radiation for limited-stage diseaseinclude the following:

  • Cisplatin 60 mg/m 2 IV on day 1 plus  etoposide 120 mg/m 2 IV on days 1-3 every 21d for 4 cycles [3] or
  • Cisplatin 80 mg/m 2 IV on day 1 plus  etoposide 100 mg/m 2 IV on days 1-3 every 28d for 4 cycles [4]
  • Carboplatin AUC 5-6 IV day 1 plus  etoposide 100 mg/m 2 IV days 1-3 every 21d [5]
  • Radiotherapy for limited-stage disease should start with cycle 1 or 2 of chemotherapy

Chemotherapy recommendations for patients not able to tolerate concurrent chemotherapy and radiation:

  • Patients with limited-stage (stages I–III) disease who are not able to tolerate chemotherapy and radiation concurrently should be treated with chemotherapy as first-line therapy
  • Cisplatin 60-80 mg/m 2 IV on day 1 plus  etoposide 80-120 mg/m 2 IV on days 1-3 every 21-28d (maximum of 4 cycles) [3, 4] or
  • Carboplatin AUC 5-6 IV on day 1 plus  etoposide 80-100 mg/m 2 IV on days 1-3 every 28d (maximum of 4 cycles) [6] (see also the Carboplatin AUC Dose Calculation [Calvert formula] calculator)

First-line chemotherapy for extensive-stage disease

Stage IV disease:

  • The following treatment recommendations should be given for a maximum of 4-6 cycles:
  • Cisplatin 60-80 mg/m 2 IV on day 1 plus  etoposide 80-120 mg/m 2 IV on days 1-3 every 21-28d [7, 8, 9, 10, 11, 12, 13, 14] or
  • Carboplatin AUC 5-6 IV on day 1 plus  etoposide 80-100 mg/m 2 IV on days 1-3 every 28d [14, 15, 16, 17] or
  • Cisplatin 60 mg/m 2 IV on day 1 plus  irinotecan 60 mg/m 2 IV on days 1, 8, and 15 every 28d [9, 12, 13] or
  • Cisplatin 30 mg/m 2 IV on days 1 and 8 or 80 mg/m 2 IV on day 1 plus  irinotecan 65 mg/m 2 IV on days 1 and 8 every 21d [8, 10] or
  • Carboplatin AUC 5 IV on day 1 plus  irinotecan 50 mg/m 2 IV on days 1, 8, and 15 every 28d [15, 17] or
  • Carboplatin AUC 4-5 IV on day 1 plus  irinotecan 150-200 mg/m 2 IV on day 1 every 21d [18, 19, 20] or
  • Cyclophosphamide 800-1000 mg/m 2 IV on day 1 plus  doxorubicin 40-50 mg/m 2 IV on day 1 plus  vincristine 1-1.4 mg/m 2 IV on day 1 every 21-28d [21, 22, 23]

Second-line chemotherapy for relapsed or refractory disease

Stage IV disease [8] :

  • Second-line chemotherapy is given for at least 4-6 cycles but can be given until disease progression as tolerated in some cases
  • Patients who have relapsed disease more than 6mo after completing first-line chemotherapy can be treated with that original first-line regimen (typically a platinum-based doublet) again, with and expected response rate of 62-100% [2, 1]
  • Etoposide 50 mg/m 2 PO daily for 3wk every 4wk [24] or
  • Topotecan 2.3 mg/m 2 PO on days 1-5 every 21d [25, 26, 27] or
  • Topotecan 1.5 mg/m 2 IV on days 1-5 every 21d [25, 26, 28] or
  • Carboplatin AUC 5 IV on day 1 plus  irinotecan 50 mg/m 2 IV on days 1, 8, and 15 every 28d [15, 17] or
  • Carboplatin AUC 4 - 5 IV on day 1 plus  irinotecan 150-200 mg/m 2 IV on day 1 every 21d [18, 19, 20] or
  • Cisplatin 30 mg/m 2 IV on days 1, 8, and 15 plus  irinotecan 60 mg/m 2 IV on days 1, 8, and 15 every 28d [29] or
  • Cisplatin 60 mg/m 2 IV on day 1 plus  irinotecan 60 mg/m 2 IV on days 1, 8, and 15 every 28d [9, 13] or
  • Cisplatin 30 mg/m 2 IV on days 1 and 8 or 80 mg/m 2 IV on day 1 plus  irinotecan 65 mg/m 2 IV on days 1 and 8 every 21d [8, 10] or
  • Paclitaxel 80 mg/m 2 IV weekly for 6wk every 8wk [30] or
  • Paclitaxel 175 mg/m 2 IV on day 1 every 3wk [31]
  • Institution Review Board (IRB) - approved clinical trial

Third-line chemotherapy for relapsed or refractory disease

Stage IV disease [1] :

  • Etoposide 50 mg/m2 PO daily for 3wk every 4wk [24] or
  • Topotecan 2.3 mg/m2 PO on days 1-5 every 21d [25, 26, 27] or
  • Topotecan 1.5 mg/m2 IV on days 1-5 every 21d [25, 26, 28] or
  • Carboplatin AUC 5 IV on day 1 plus irinotecan 50 mg/m2 IV on days 1, 8, and 15 every 28d [15, 17] or
  • Carboplatin AUC 4-5 IV on day 1 plus irinotecan 150-200 mg/m2 IV on day 1 every 21d [18, 19, 20] or
  • Cisplatin 30 mg/m2 IV on days 1, 8, and 15 plus irinotecan 60 mg/m2 IV on days 1, 8, and 15 every 28d [29] or
  • Cisplatin 60 mg/m2 IV on day 1 plus irinotecan 60 mg/m2 IV on days 1, 8, and 15 every 28d [9, 13] or
  • Cisplatin 30 mg/m2 IV on days 1 and 8 or 80 mg/m2 IV on day 1 plus irinotecan 65 mg/m2 IV on days 1 and 8 every 21d [8, 10] or
  • Paclitaxel 80 mg/m2 IV weekly for 6wk every 8wk [30] or
  • Paclitaxel 175 mg/m2 IV on day 1 every 3wk [30]
  • IRB-approved clinical trial

Special considerations

See the list below:

  • Patients with mixed SCLC/non-SCLC histology should be given the same treatment as patients with SCLC [1, 2]
  • Prophylactic cranial irradiation is recommended for SCLC patients with a complete or partial remission (total of 25 Gy in 10 fractions or 30 Gy in 10-15 fractions) [1, 2]
  • Dose dense or dose escalation chemotherapy regimens are not recommended outside of a randomized clinical trial [1, 2]
  • Patients with brain metastases can receive chemotherapy prior to brain radiation due to high response rates with chemotherapy [1, 2]
  • An advancement in treatment has come with the emergence of immune checkpoint inhibitors. Studies are now investigating the administration of single-agent pembrolizumab in patients with non-SCLC [32]
  • A study evaluating treatment of patients with stereotactic body radiation therapy concluded that it is a promising alternative to surgery for patients with stage I non-SCLC [33]