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Cancer Medicine :: Lung Cancer -Small cell Treatment

Lung Cancer -Small cell

Making treatment decisions for small cell lung cancer

Depending on the stage of the disease and other factors, the main treatment options for people with small cell lung cancer (SCLC) include:

Surgery

Radiation therapy

Chemotherapy

If you have small cell lung cancer, you will probably get chemotherapy if you are healthy enough. If you have limited stage disease, radiation therapy and – rarely – surgery may be options as well.

                                                    

After the cancer is found and staged, your cancer care team will discuss your treatment options with you. It is important to take time and think about all of your possible choices. In choosing a treatment plan, one of the most important factors to consider is the stage of the cancer. For this reason, it is very important that your doctor order all the tests needed to determine the cancer's stage.

Other factors to consider include your overall health, the likely side effects of the treatment, and the probability of curing the disease, extending life, or relieving symptoms. Age alone should not be a barrier to treatment. Older people can benefit from treatment as much as younger people as long as their general health is good.

You may have different types of doctors on your treatment team, depending on the stage of your cancer and your treatment options. These doctors may include:

A medical oncologist: a doctor who treats cancer with medicines such as chemotherapy.

A pulmonologist: a doctor who specializes in medical treatment of diseases of the lungs.

A radiation oncologist: a doctor who treats cancer with radiation therapy.

A thoracic surgeon: a doctor who treats diseases in the lungs and chest with surgery.

Many other specialists may be involved in your care as well, including nurse practitioners, nurses, respiratory therapists, social workers, and other health professionals.

Small-cell lung cancer surgery

Surgery is rarely used as the main form of treatment in small cell lung cancer (SCLC). Occasionally (fewer than 1 out of 20 cases), the cancer is found as only one localized tumor nodule, with no spread to lymph nodes or other organs. Surgery may be an option usually followed by additional treatment (chemotherapy, often with radiation therapy).

If your doctor thinks the lung cancer can be treated with surgery, pulmonary function tests will be done first to determine whether you will have enough healthy lung tissue remaining after surgery. Other tests will check the function of your heart and other organs to be sure you're healthy enough for surgery.

Because more advanced stage lung cancers are not helped by surgery, your doctor will also want to make sure the cancer hasn't already spread to the lymph nodes between the lungs. 

Types of lung surgery

Several different operations can be used to treat lung cancers. These operations require general anesthesia (where you are in a deep sleep) and a surgical incision between the ribs in the side of the chest (called a thoracotomy).

Pneumonectomy: an entire lung is removed.

Lobectomy: a section (lobe) of the lung is removed.

Segmentectomy or wedge resection: part of a lobe is removed.

Sleeve resection: a section of a large airway is removed and the lung is reattached.

In general, lobectomy is the preferred operation for small cell lung cancers treated with surgery.

With any of these operations, nearby lymph nodes are also removed to look for possible spread of the cancer.

You will generally need to spend about a week in the hospital after the surgery.

Video-assisted thoracic surgery: Some doctors now treat some early stage lung cancers near the outside of the lung with a procedure called video-assisted thoracic surgery (VATS), which is less invasive than a thoracotomy.

During this operation, a thin, hollow tube with a tiny video camera on the end is placed through a small hole in the side of the chest to help the surgeon see the chest cavity on a TV monitor. One or two other small holes are created in the skin, and long instruments passed though these holes are used to cut away the tumor. One of the incisions may need to be enlarged to remove the lung specimen. Usually, only small incisions are needed, so there is a little less pain after the surgery and a shorter hospital stay, usually around 4 to 5 days.

Most experts recommend that only tumors smaller than 3 to 4 centimeters (about 1 ½ inches) near the outside of the lung be removed this way. The cure rate after this surgery seems to be the same as with older techniques. But it is important that the surgeon be experienced with this procedure since it requires a great deal of technical skill.

Possible risks and side effects of lung surgery

Possible complications during and soon after surgery depend on the extent of the surgery and a person's health beforehand. Serious complications can include excessive bleeding, wound infections, and pneumonia. While it is rare, in some cases people may not survive the surgery, which is why it is very important that surgeons select patients carefully.

Surgery for lung cancer is a major operation, and recovering from the operation typically takes weeks to months. The surgeon must spread ribs to get to the lung when doing a thoracotomy, so the incision will hurt for some time after surgery. Your activity will be limited for at least a month.

If your lungs are in good condition (other than the presence of the cancer) you can usually return to normal activities after some time if a lobe or even an entire lung has been removed. If you also have non-cancerous lung diseases such as emphysema or chronic bronchitis (which are common among heavy smokers), you may become short of breath with activities after surgery.

Surgery and other techniques to relieve symptoms of SCLC

In some cases, surgery (or other localized techniques) may be used to help treat the symptoms of the cancer (as opposed to trying to remove all of the cancer). For example, tumors can sometimes grow into airways, blocking them and causing problems such as pneumonia or shortness of breath. Treatments such as laser surgery can be used to relieve the blockage in the airway. This is done using a special type of laser on the end of a bronchoscope to destroy the tumor cells. A bronchoscope may also be used to place a metal or silicone tube (called a stent) in the airway after treatment to help keep it open. Other techniques like radiation therapy may also be used.

Sometimes fluid can build up in the chest cavity outside of the lungs. It can press on the lungs and cause trouble breathing. To remove the fluid and keep it from coming back, doctors sometimes perform a procedure calledpleurodesis. A small cut is made in the skin of chest wall, and a hollow tube is placed into the chest to remove the fluid. Either talc or a drug such as doxycycline or a chemotherapy drug is then instilled into the chest cavity. This causes the linings of the lung (visceral pleura) and chest wall (parietal pleural) to stick together, sealing the space and limiting further fluid buildup. The tube is generally left in for a couple of days to drain any new fluid that might accumulate.

Radiation therapy for small-cell lung cancer

Radiation therapy uses high-energy rays (such as x-rays) or particles to kill cancer cells. External beam radiation therapy (EBRT) delivers radiation from outside the body that is focused on the cancer. This is the type of radiation therapy most often used to treat small cell lung cancer.

In small cell lung cancer (SCLC), radiation therapy may be used in several situations:

It is most often given at the same time as chemotherapy in limited stage disease to treat the tumor and lymph nodes in the chest. After chemotherapy, radiation therapy is sometimes used to kill any small deposits of cancer that may remain.

It can be used to shrink tumors to palliate (relieve) symptoms of lung cancer such as bone pain, bleeding, trouble swallowing, cough, shortness of breath, and problems caused by brain metastases.

In limited SCLC, it is often given to the brain after other treatments, to help reduce the chances that the cancer will spread there. (The brain is a common site of metastasis.) This is called prophylactic cranial irradiation.

Before your treatments start, the radiation team will take careful measurements to find the correct angles for aiming the radiation beams and the proper dose of radiation. Radiation therapy is much like getting an x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time – getting you into place for treatment – usually takes longer.

Most often, radiation treatments as part of the initial treatment for SCLC are given once or twice daily, 5 days a week, for 3 to 7 weeks. Radiation to relieve symptoms and prophylactic cranial radiation are given for shorter periods of time.

Standard (conventional) EBRT isn't used as much as it used to be. Newer techniques help doctors treat lung cancers more accurately while lowering the radiation exposure to nearby healthy tissues. These techniques may offer better chances of increasing the success rate and reducing side effects. Most doctors now recommend using these newer techniques when they are available.

Three-dimensional conformal radiation therapy (3D-CRT): 3D-CRT uses special computer programs to precisely map the location of the tumor(s). Radiation beams are shaped and aimed at the tumor(s) from several directions, which makes it less likely to damage normal tissues.

Intensity modulated radiation therapy (IMRT): IMRT is an advanced form of 3D therapy. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the tumor from several angles, the intensity (strength) of the beams can be adjusted to minimize the dose reaching the most sensitive normal tissues. This technique is used most often if tumors are near important structures such as the spinal cord.

Possible side effects of radiation therapy

Common side effects of radiation therapy include;

Sunburn-like skin problems

Hair loss (in the area where the radiation enters the body)

Fatigue

Nausea and vomiting

Loss of appetite and weight loss

Low blood counts

Radiation therapy can affect the blood-forming cells in the bone marrow. This can lead to low blood counts. The red blood cells and white blood cells are most often affected by radiation, but sometime the platelets are affected, too. This can lead to:

Increased chance of infections (from low white blood cell counts)

Easy bruising or bleeding (from low blood platelet counts)

Fatigue (from low red blood cell counts)

When chemotherapy is given with radiation, many of the side effects are worse.

Chest radiation therapy may cause some damage to your lungs, which might cause a cough, problems breathing, and shortness of breath. These usually improve after treatment is over, although in some cases the symptoms may not go away completely.

Your esophagus, which is in the middle of your chest, may be exposed to radiation, which could cause a sore throat and trouble swallowing during treatment. This may make it hard to eat anything other than soft foods or liquids for a while.

Radiation therapy to large areas of the brain can sometimes cause memory loss, headaches, trouble thinking, or reduced sexual desire. Usually these symptoms are minor compared with those caused by a brain tumor, but they can reduce your quality of life. Side effects of radiation therapy to the brain usually become most serious 1 or 2 years after treatment.

Most side effects improve and go away after treatment, but some can last a long time, or may even be permanent.

Small-cell lung cancer chemotherapy

Chemotherapy is treatment with anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and go throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the lung. Chemotherapy is usually the main treatment for small cell lung cancer (SCLC).

Doctors give chemotherapy in cycles, with a period of treatment (usually 1 to 3 days) followed by a rest period to allow your body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks, and initial treatment typically is 4 to 6 cycles. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

Chemotherapy for SCLC generally uses a combination of 2 drugs. The drug combinations most often used for initial chemotherapy for SCLC are:

Cisplatin and etoposide

Carboplatin and etoposide

Cisplatin and irinotecan

Carboplatin and irinotecan

Cyclophosphamide, doxorubicin (Adriamycin®), and vincristine

If the cancer progresses (get worse) during treatment or returns after treatment is finished, different chemotherapy drugs may be tried. The choice of drugs depends to some extent on how soon the cancer begins to grow again. (The longer it takes for the cancer to return, the more likely it is to respond to further treatment.)

If the cancer progresses during treatment or relapses (returns) within 2 to 3 months of finishing treatment, drugs such as topotecan, ifosfamide, paclitaxel, docetaxel, irinotecan, or gemcitabine may be tried.

If the relapse occurs from 2 to 3 months to 6 months after treatment, topotecan is often the drug of choice. Other drugs that may be tried include irinotecan, the CAV regimen (cyclophosphamide, doxorubicin, and vincristine), gemcitabine, paclitaxel, docetaxel, oral etoposide, or vinorelbine.

For relapses 6 or more months after treatment, the original chemotherapy regimen may still be effective and can often be tried again.

Possible side effects of chemotherapy

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

Hair loss

Mouth sores

Loss of appetite

Nausea and vomiting

Diarrhea or constipation

Increased chance of infections (from low white blood cell counts)

Easy bruising or bleeding (from low blood platelet counts)

Fatigue (from low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting.

Some side effects can be more long lasting. For example, drugs such as cisplatin, vinorelbine, docetaxel, or paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy. In most cases this improves after treatment is stopped, but it may be long lasting in some people. 

Also, cisplatin can cause kidney damage (called nephropathy). To help prevent this, doctors give lots of fluid IV before and after each dose of the drug is given.

You should report any side effects you notice while getting chemotherapy to your medical team so that they can be treated promptly. In some cases, the doses of the chemotherapy drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.

Complementary and alternative therapies for small-cell lung cancer

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that your doctor hasn't mentioned. Everyone from friends and family to Internet groups and Web sites may offer ideas for what might help you. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

What exactly are complementary and alternative therapies?

Not everyone uses these terms the same way, and they are used to refer to many different methods, so it can be confusing. We use complementary to refer to treatments that are used along with your regular medical care.Alternative treatments are used instead of a doctor's medical treatment.

Complementary methods: Most complementary treatment methods are not offered as cures for cancer. Mainly, they are used to help you feel better. Some methods that are used along with regular treatment are meditation to reduce stress, acupuncture to help relieve pain, or peppermint tea to relieve nausea. Some complementary methods are known to help, while others have not been tested. Some have been proven not be helpful, and a few have even been found harmful.

Alternative treatments: Alternative treatments may be offered as cancer cures. These treatments have not been proven safe and effective in clinical trials. Some of these methods may pose danger, or have life-threatening side effects. But the biggest danger in most cases is that you may lose the chance to be helped by standard medical treatment. Delays or interruptions in your medical treatments may give the cancer more time to grow and make it less likely that treatment will help.

Treatment choices by stage for small cell lung cancer

As mentioned in "How is small cell lung cancer staged?", for practical reasons small cell lung cancer (SCLC) is usually staged as either limited or extensive. In most cases, SCLC has already spread by the time it is found (even if that spread is not seen on x-rays and other imaging tests), so it usually cannot be treated by surgery alone. If you are healthy enough, you will probably get chemotherapy (chemo), regardless of the stage of your disease.

If you smoke, one of the most important things you can do to be ready for treatment is to try to quit. Studies have shown that patients who stop smoking after a diagnosis of lung cancer tend to have better outcomes than those who don't.

Stage I SCLC

If you only have a single small tumor in your lung with no evidence of cancer in lymph nodes or elsewhere, your doctors may recommend surgery to remove the tumor and the nearby lymph nodes. This is only an option if you are in fairly good health and able to tolerate removing all or part of a lung. You will be checked for signs of cancer spread to the lymph nodes in the chest with mediastinoscopy or other tests before this is considered. Very few patients with SCLC are treated this way.

Surgery is generally followed by chemo. Radiation to the chest is usually advised as well if cancer is found in the lymph nodes that were removed. The radiation is often given at the same time as the chemo. Although this increases the side effects of treatment, it appears to be more effective than giving one treatment after the other. You may not be given radiation therapy if you already have severe lung disease (in addition to your cancer) or other serious health problems.

Limited stage SCLC

For most cases of limited stage SCLC, surgery is not an option because the tumor is too large, or has spread to nearby lymph nodes or other places in the lung. If you are in good health, the standard treatment is chemo plus radiation (given at the same time). People given these treatments together live longer and have a better chance of cure, but this treatment combination is hard to take.

If you have lung problems or other major health problems, chemotherapy may be given alone.

If no preventive measures are taken, about half of people with SCLC will have cancer spread (metastasis) to their brain. For this reason, if your cancer has responded well to initial treatment, you may be given radiation therapy to the head (prophylactic cranial irradiation, or PCI) to try to prevent spread to the brain. The radiation is usually given in lower doses than that for treatment of known metastases. Still, some patients given PCI may have side effects, such as those described in the "Radiation therapy" section.

Most people treated with chemotherapy (with or without radiation) for their limited stage SCLC will have their tumors shrink significantly. In about half of these people, the cancer will shrink to the point where it can no longer be seen on imaging tests. Unfortunately, the cancer will still return at some point in most people.

Clinical trials of new chemotherapy drugs and combinations, as well as other new treatments, are being done to improve on current treatment results. Because these cancers are hard to cure, a clinical trial may be a good option for some people. If you think you might be interested in taking part in a clinical trial, talk to your doctor.

Extensive stage SCLC

If you have extensive SCLC and are in fairly good health, chemotherapy can often treat your symptoms and also help you live longer.  About 3 out of 4 people will have their cancer shrink significantly with chemotherapy. Unfortunately, the cancer will still return at some point in almost all people with extensive stage SCLC.

If the cancer responds well to chemo, radiation treatments to the brain may also be considered to prevent future problems (prophylactic cranial irradiation).

Because these cancers are hard to treat, clinical trials of new chemotherapy drugs and combinations, as well as other new treatments, may be a good option for some people. If you think you might be interested in taking part in a clinical trial, talk to your doctor.

Radiation therapy is sometimes used to help shrink tumors and control symptoms in a specific part of the body, such as if cancer growth within the lungs is causing shortness of breath or bleeding. Other types of treatment, such as laser surgery, can also sometimes be helpful in these situations. Radiation therapy can also be used to relieve symptoms if the cancer has spread to the bones or brain.

If your general health is poor, you may not be able to withstand the side effects of chemotherapy or benefit from it. In this case, your doctor may select a treatment plan based on your individual medical situation. If you are too ill to have chemotherapy, the best plan may be to have supportive care. This would include treatment of any pain, breathing problems, or other symptoms you might have.

Cancer that progresses or recurs after treatment

If the cancer continues to grow during treatment or comes back, any further treatment will depend on the extent of the cancer, what treatments have been used, and a person's health and desire for further treatment. It is always important to understand the goal of any further treatment before it starts – if it is to try to cure the cancer, to slow its growth, or to help relieve symptoms – as well as the likelihood of benefits and risks.

If a cancer continues to grow during chemotherapy, another type of chemotherapy may be tried, although it may be less likely to be effective. For cancers that come back after initial treatment is finished, the choice of chemotherapy drugs may depend on how long the cancer was in remission .

At some point, it may become clear that standard treatments are no longer controlling the cancer. If you want to continue anti-cancer treatment, you might think about taking part in a clinical trial of newer lung cancer treatments. Although these are not always the best option for every person, they may benefit you as well as future patients.

Even if your cancer can't be cured, you should be as free of symptoms as possible. If curative treatment is not an option, treatment aimed at specific sites can often relieve symptoms and may even slow the spread of the disease. Symptoms caused by cancer in the lung airways – such as shortness of breath or coughing up blood – can often be treated effectively with radiation therapy, laser therapy, or other local treatments if needed. Radiation therapy can be used to help control cancer spread in the brain or relieve pain if cancer has spread to the bones.

Many people with lung cancer are concerned about pain. If the cancer grows near certain nerves it can sometimes cause pain, but this can almost always be treated effectively with pain medicines. Sometimes radiation therapy or other treatments will help as well. It is important that you talk to your doctor and take advantage of these treatments.

What happens after treatment for small cell lung cancer?

For some people with lung cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You may be relieved to finish treatment, but find it hard not to worry about cancer growing or coming back. (When cancer comes back after treatment, it is called recurrence.) This is a very common concern in people who have had cancer.

It may take a while before your fears lessen. But it may help to know that many cancer survivors have learned to live with this uncertainty and are living full lives. 

For some other people, the lung cancer may never go away completely. You may get regular treatments with chemotherapy, radiation therapy, or other therapies to help keep the cancer in check. Learning to live with cancer as more of a chronic disease can be difficult and very stressful. It has its own type of uncertainty. 

Follow-up care

During and after treatment, your doctors will want to watch you closely. It is very important to keep all follow-up appointments. During these visits, your doctors will ask about symptoms, do physical exams, and may order blood tests or imaging tests such as CT scans or x-rays.

In people with no signs of cancer remaining, most doctors recommend follow-up visits (which may include CT scans and blood tests) about every 2 to 3 months for the first year after treatment, every 3 to 6 months for the next several years, then at least yearly after 5 years.

Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is the time for you to ask your health care team any questions you need answered and to discuss any concerns you might have.

Each type of treatment for lung cancer can have side effects. Some may last for a few weeks to several months, but others can last the rest of your life. It is important for you to report any new or recurring symptoms right away. Don't hesitate to tell your cancer care team about any symptoms or side effects that bother you so they can help you manage them.

It is important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

What`s new in small cell lung cancer research and treatment?

Lung cancer is currently being researched in medical centers throughout the world. Progress in prevention, early detection, and treatment based on current research is expected to save many thousands of lives each year.

Prevention

Tobacco

At this time, many researchers believe that prevention offers the greatest opportunity to fight lung cancer. Although decades have passed since the link between smoking and lung cancers was clearly identified, scientists estimate that smoking is still responsible for about 87% of lung cancer deaths, and this percentage is likely even higher for small cell lung cancers. Research is continuing on:

Ways to help people quit smoking through counseling, nicotine replacement, and other medicines

Ways to convince young people to never start smoking

Inherited differences in genes that may make some people much more likely to get lung cancer if they smoke or are exposed to someone else's smoke

Diet, nutrition, and medicines

Although researchers are looking for ways to use vitamins or medicines to prevent lung cancer in people at high risk, so far none have been shown conclusively to reduce risk. Some studies have suggested that a diet high in fruits and vegetables may offer some protection, but more research is needed to confirm this. For now, most researchers think that simply following the American Cancer Society dietary recommendations (such as maintaining a healthy weight and eating a diet high in fruits, vegetables, and whole grains) may be the best strategy.

Early detection

As mentioned in the section "Can non-small cell lung cancer be found early?", a large clinical trial called the National Lung Screening Trial (NLST) found that spiral CT scanning in people at high risk of lung cancer (due to smoking history) lowered the risk of death from lung cancer, when compared to chest x-rays. This finding has led to the development of screening guidelines for lung cancer.

Another approach uses newer, more sensitive tests to look for cancer cells in sputum samples. Researchers have recently found several changes that often affect the DNA of lung cancer cells. Current studies are looking at new diagnostic tests that specifically recognize these DNA changes to see if this approach is useful in finding lung cancers at an earlier stage.

Diagnosis

Fluorescence bronchoscopy

Also known as autofluorescence bronchoscopy, this technique may help doctors find some lung cancers earlier, when they may be easier to treat. For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light.

The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference may help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy.

Virtual bronchoscopy

This imaging test uses CT scans to create detailed 3-dimensional pictures of the airways in the lungs. The images can be seen as if the doctor were actually using a bronchoscope.

Virtual bronchoscopy has some possible advantages over standard bronchoscopy. First, it is non-invasive and doesn't require anesthesia. It also helps doctors look at some airways that might not be seen with standard bronchoscopy, such as those being blocked by a tumor. But it has some drawbacks as well. For example, it doesn't show color changes in the airways that might indicate a problem. It also doesn't allow a doctor to take samples of suspicious areas like bronchoscopy does. Still, it may be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy.

This test will probably become more available as the technology improves.

Treatment

Chemotherapy

Many clinical trials are being done to compare the effectiveness of newer combinations of chemotherapy drugs. These studies are also looking to reduce side effects, especially in patients who are older and have other health problems. Doctors are also searching for better ways to combine chemotherapy with radiation therapy and other treatments.

Some new chemotherapy drugs, such as amrubicin and picoplatin, have shown promising results in early studies and are now being tested in larger clinical trials.

Targeted therapies

Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. This is being used to develop new targeted therapies. These drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. Many of these treatments are already being tested in clinical trials to see if they can help people with advanced lung cancer live longer or relieve their symptoms.

Anti-angiogenesis drugs: For cancers to grow, new blood vessels must develop to nourish the cancer cells within tumors. This process is called angiogenesis. New drugs that inhibit angiogenesis are being studied as lung cancer treatments.

Some have already been successfully used for other cancer types. For example, a drug called bevacizumab (Avastin) has been shown to help patients with some types of non-small cell lung cancer. In a study of small cell lung cancer, it helped stop some of the cancers from growing for a time, but didn’t seem to help the patients live longer. Other drugs already approved for use against other types of cancer, such as sunitinib (Sutent) and sorafenib (Nexavar), are also being tested for use against SCLC.

Vaccines: Several types of vaccines for boosting the body's immune response against lung cancer cells are being tested in clinical trials. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. One possible advantage of these types of treatments is that they seem to have very limited side effects, so they might be useful in people who can't tolerate other treatments. At this time, vaccines are only available in clinical trials.

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