Despite initial chemosensitivity, increasing long-term survival in SCLC remains an elusive goal. In a patient population in which our goals are to palliate, maintaining quality of life and minimizing toxicity are equally important objectives. This latter point appears particularly pertinent to the quest for increased dose intensity in extensive-stage SCLC. SCLC patients tend to be older and commonly manifest comorbidities such as cardiovascular and obstructive lung disease that make them poor candidates for dose-intense therapy. The most promising therapeutic results of the last 20 yearsthe data from the Japanese Clinical Oncology Group with irinotecan and Pare based not on the concepts of dose intensity but rather on the concepts of drug diversity. It is hoped that these data will be confirmed by ongoing trials. Lastly, it is anticipated that selective antineoplastic therapies that target the underlying molecular abnormalities that characterize SCLC will offer promise for the future.
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