Small Cell Lung Cancer (SCLC): Options After First Treatment

This article is for people who have relapsed small cell lung cancer (SCLC), their caregivers and family, or anyone else who wants to learn more about this condition. The goal of this patient education activity is to improve the knowledge of patients and caregivers regarding available treatment options for relapsed SCLC.

You will learn about:

• What extensive-stage SCLC (ES-SCLC) is

• Treatment options for SCLC

• Treatment after relapse

• Side effects of treatment

• Making a plan with your doctor and healthcare team

• Questions to ask

All medicines listed in this activity are not FDA approved for extensive-stage small cell lung cancer (ES-SCLC), but are recommended by the National Comprehensive Cancer Network (NCCN).

Small cell lung cancer, or SCLC, is a type of lung cancer that can grow quickly. About 10% to 15% of all lung cancers are SCLC.

Sometimes cancer can spread -- or metastasize -- to other parts of the body. Extensive-stage SCLC, or ES-SCLC, is cancer that has spread. Most times, SCLC has already spread by the time it's first diagnosed. Other times, it can spread after it's treated. Your doctor will check to see if your SCLC has spread to determine what stage it's in and help plan treatment.

Sometimes limited-stage SCLC (LS-SCLC) or ES-SCLC can come back after it's been treated. When it returns after first treatment, it's called recurrent or relapsed.

Treatment for LS-SCLC and ES-SCLC can be local or systemic. Local treats a specific area of the body, while systemic targets the entire body.

The first treatment used is called first-line. If one treatment doesn't work (or stops working) and cancer continues to grow or spread, other options may work. These are called second- and third-line treatments.

Not every treatment for LS-SCLC or ES-SCLC can be used as first-, second-, or third-line. Which treatment your doctor recommends will depend on what stage your SCLC is in, if it has spread and where to, other treatments you had, and your overall health and wishes.

Surgery, radiation, chemotherapy, and immunotherapy are types of treatment that your doctor may recommend as first-line treatment for SCLC.

With ES-SCLC, it has often spread too far for local treatment such as surgery. In these cases, your doctor may recommend systemic therapy with chemotherapy, immunotherapy, or a combination of treatments.

Treatments for ES-SCLC may include:

• Chemotherapy, either alone or with immunotherapy, as first-line treatment

• Chemotherapy or immunotherapy as second- or third-line treatment after first-line

• Radiation therapy

• Joining a clinical trial

If SCLC has relapsed (comes back), your doctor may recommend the same treatment again, or a second- or third-line treatment such as:

• Chemotherapy, such as topotecan, irinotecan, lurbinectedin, paclitaxel, docetaxel, temozolomide, vinorelbine, etoposide, gemcitabine, or a combination of cyclophosphamide, doxorubicin, and vincristine

• Immunotherapy, such as pembrolizumab, or nivolumab with or without ipilimumab

• Radiation therapy, laser therapy, or a stent (to keep airways open) to relieve symptoms and improve your quality of life

• Supportive care to prevent or control cancer symptoms and treatment side effects

• Joining a clinical trial

Which treatment your doctor recommends will be based on SCLC location and amount of spread, previous treatment you had, when relapse happened, and your personal preferences.

All treatments can have side effects. Talk with your doctor before treatment about when you should call your doctor or go to the emergency room because of side effects.

Side effects that may happen with chemotherapy include:

• Fatigue (tiredness, weakness)

• Nausea

• Liver problems

• Decreases in certain blood cell levels

Those that may happen with immunotherapy include:

• Constipation

• Fatigue (tiredness, weakness)

• Nausea

• Skin rash

Contact your doctor right away if you have abdominal (belly) pain, decreased appetite, diarrhea, vomiting, unusual bruising or bleeding, or signs of infection (fever, chills, body aches).

Not all side effects are listed here. Ask your doctor, healthcare team, or pharmacist for a complete list.

You'll work with your doctor to create a treatment plan. It can include which treatments are best for you and when to start, switch, or stop treatment.

Tell your doctor about your symptoms and any side effects, and how they affect your daily life. Together, you can discuss ways to manage them.

Also mention all medicines you take -- including those you can get without a prescription -- and all supplements or herbals.

You can record your symptoms and side effects in a journal or diary. This can be especially helpful when you talk to your doctor.

Questions you can ask your doctor about your care and treatment plan can include:

• What treatments are available, and what are their side effects?

• What are the goals of treatment?

• What's the best way to manage my symptoms and treatment side effects?

• How will we know if treatment is working?

• Is there a clinical trial that might be right for me?

• How can I make sure I have the best quality of life possible?

• Are there any lifestyle changes I should make?

• What should I do if I feel stressed or depressed?

Congratulations! You have successfully completed the program: Small Cell Lung Cancer (SCLC): Options After First Treatment.

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