Small Cell Lung Cancer Treatments by Stage

Small cell lung cancer (SCLC) accounts for about 15 out of every 100 (15%) lung cancer cases. After decades of bery few changes in the treatment of SCLC, there are now more treatment options, which have shifted the standard of care and bring renewed hope. Whether you’ve just been diagnosed with SCLC or are further down your treatment path, it’s important to know all of your treatment options so you can make informed decisions about your care.  

SCLC stages

SCLC treatments are approved for use at different stages of the disease. While many cancers are divided into 4 stages: 1 (I), 2 (II), 3 (III), and 4 (IV) according to the size and location of tumors, SCLC is usually divided into 2 stages.  

• Limited-Stage SCLC: Includes stages 1-3 (I-III), when the cancer is on one side of the chest and has not spread very far. 

• Extensive-Stage SCLC: Includes stage 4 (IV), when the cancer has spread beyond one side of the chest to other lung areas, lymph nodes, and/or distant organs. 

Your specific treatment options will be based on the stage of lung cancer, your previous treatments, the location of lung cancer in the body, and your overall health. 

Limited-stage SCLC treatments

In limited-stage SCLC, approved treatments may include one or more of the following: 

• Chemotherapy + Radiation: This is the most common treatment for limited-stage SCLC. Giving chemotherapy and radiation at the same time often works better, though you may receive them one after the other, depending on your overall health. 

• Chemotherapy kills fast-growing cells in the body, like cancer cells, and is given in repeated cycles, often over several months. Two chemotherapy medicines (etoposide plus either carboplatin or cisplatin) are combined to treat SCLC. 

• Radiation therapy (chest radiation) uses high-energy beams to kill or shrink cancer cells or prevent them from spreading.  

• Immunotherapy: Checkpoint inhibitors are a type of immunotherapy that activate your immune system to find and fight cancer cells. Imfinzi (durvalumab) is the checkpoint inhibitor approved for use after chemotherapy and radiation are completed if cancer has not spread. 

• Surgery: Removing cancer through surgery may be an option if it’s found very early. The surgeon will often also remove and examine nearby lymph nodes to ensure the cancer has not spread.  

Extensive-stage SCLC treatments

In extensive-stage SCLC, your first treatment(s) after diagnosis may include 1 or more of the following: 

• Chemotherapy: The same chemotherapy drugs used in limited-stage SCLC (etoposide plus carboplatin or cisplatin) may be used as initial treatment for extensive-stage SCLC.  

• Immunotherapy: Imfinzi (durvalumab) or Tecentriq (atezolizumab) are the checkpoint inhibitors approved for use during or after chemotherapy is complete. 

• Radiation therapy: This treatment may be used to treat areas in the body that didn’t respond to other treatments, or to relieve symptoms. There are also specialized types of radiation used to treat SCLC that has spread to the brain. 

If your scans show that the cancer has completely or partially responded to your last round of chemotherapy, or if the cancer is stable and not growing, your healthcare team may discuss starting maintenance therapy. This is the continued use of certain treatments with the goal of keeping cancer from growing. Approved maintenance treatments for extensive-stage SCLC include: 

• Immunotherapy: The checkpoint inhibitors, Imfinzi (durvalumab) or Tecentriq (atezolizumab) may be used after chemotherapy is complete as long as they continue to be effective. 

• Tecentriq (atezolizumab) combined with Zepzelca (lurbinectedin): Recent studies have shown that Tecentriq (atezolizumab) combined with the chemotherapy drug Zepzelca (lurbinectedin) is more effective as maintenance therapy than Tecentriq (atezolizumab) alone.  

Treatment options if SCLC grows or spreads

If your scans show that SCLC has grown or has spread while on your current treatment, a different treatment will be needed. Your healthcare team will talk to you about your options, including well-established treatments, newly approved treatments, and clinical trials. Your options may include one or more of the following:  

• Immunotherapy: T-cell engagers are a different type of immunotherapy that work by bringing immune cells together with cancer cells to help activate your immune system and destroy the cancer cells. Imdelltra (tarlatamab) is currently the only approved T-cell engager for SCLC and is the current standard of care when the cancer has grown or spread following chemotherapy. 

• Chemotherapy: Your treatment options depend on the type of chemotherapy used previously and how long ago it was. There are several chemotherapy options for SCLC. 

• Radiation therapy: There are different types of radiation therapy that may be used to treat specific areas of the body or to relieve symptoms and improve quality of life. 

Clinical trials

A clinical trial is a type of research study that tests new treatments or old treatments in new ways to learn how well they work and how safe they are. It’s always a good idea to discuss clinical trials any time a new treatment is needed, including when you are first diagnosed. You can talk to your healthcare team about what clinical trials may be right for you or contact our HelpLine at 1-800-298-2436 or email support@go2.org to connect with our LungMATCH treatment and clinical trial navigators.  

Palliative care

Palliative care is different than hospice care. The goal of palliative care is to improve your comfort and your quality of life, no matter the stage of cancer or where you are on your treatment path. Its purpose is to prevent or treat the symptoms and side effects of lung cancer and its treatments so you can enjoy more of life.  

Palliative care is especially important in advanced lung cancer. Studies show that people with lung cancer who receive ongoing palliative care beginning early in the treatment process not only have improved quality of life but also live longer. 

What does this mean for you?

With ongoing research and recent advances, there is increased hope for people diagnosed with SCLC. New discoveries in SCLC treatment make it even more important to ask your healthcare team about all your available treatment options. Have open discussions with your team about what is important to you and ask questions.