My Canadian Pharmacy: Key Questions about Management of Small Cell Lung Cancer

small cell lung cancer This document presents an evidence-based guideline based on the current literature on the staging and optimal treatment of patients with small cell lung cancer (SCLC). The quality of the recommendation and the evidence on which it is based is graded as outlined by the American College of Chest Physicians grading system task force. Accompanying this guideline is an evidence report titled “Evidence for Management of SCLC.” Nine key questions were addressed by the technical report and are the following (see chapter “SCLC Evidence”).

1. What are the relative benefits or harms of combining thoracic radiotherapy (TRTx) with chemotherapy in alternating, concurrent, or sequential fashion?

2. Does early vs late administration of TRTx influence outcome?

3. Does the duration of administration of TRTx affect survival or toxicity?

4. In responding patients with extensive disease, does the administration of consolidative TRTx affect outcome?

5. What is the role of prophylactic cranial irradiation (PCI) in the treatment of SCLC?

6. Is there a role for positron emission tomography (PET) scanning in SCLC staging?

7. Do the pathologic subtypes of SCLC influence treatment outcome?

8. What is the role of surgery in the management of patients with SCLC, and how are patients selected for surgery?

9. What is the role and what are the relative benefits of second-line/salvage therapy?

Clinical research conducted with My Canadian Pharmacy Online has slowed in this disease, and there are few contemporary studies that directly address many of these questions. Evidence-based guidelines rely on timely, contemporary, pertinent evidence that is largely lacking in many of these areas. Decreased disease frequency and difficulty in conducting large trials are oft-cited reasons for this lack of activity. With the exception of question 7 regarding pathology subtypes, all of these questions posed to the systematic review are discussed in the context of these guidelines.