We recently had the opportunity to speak with Dr. Charles Rudin, a leading lung cancer specialist and Deputy Director of the Cancer Center at Memorial Sloan Kettering Cancer Center, about small-cell lung cancer (SCLC).
In part one, he explains what makes SCLC unique, how it’s typically treated, and what patients and caregivers should know about prognosis and emerging therapies. You can also watch the full webinar replay, below.
The following questions and responses have been lightly edited for grammatical purposes.
1) What’s a common myth about SCLC that you’d like to address?
Dr. Rudin: For patients with limited-stage disease, disease confined to one side of the chest and amenable to radiation, about a third are now cured with aggressive multimodality therapy. Even for extensive-stage disease, where the cancer has spread outside of the chest, we now have long-term, disease-free survivors with some of the emerging therapies.
I think it’s a time of hope for patients with this disease and a time of rapidly changing approaches.
2) What is SCLC and how does it differ from non-small cell lung cancer (NSCLC)?
Dr. Rudin: SCLC has historically had a very poor prognosis. It’s a very aggressive cancer and tends to spread rapidly in the body. It is strongly associated with a history of tobacco exposure, about 98% of patients have smoked, but 2% have not. So it can occur in never-smokers as well; it’s not always tobacco-associated.
We generally stage the disease as limited or extensive. Limited-stage disease is confined to one side of the chest and is amenable to treatment with both chemotherapy and radiation. Extensive-stage disease includes everything else, basically disease that has spread beyond the capacity of a radiation field.
3) Will that staging system change at some point, or are we still using limited and extensive stages?
Dr. Rudin: Functionally, we are still using limited and extensive. Officially, there is the TNM staging system (tumor, node, metastasis, like we use for other cancers. In practice, treatment decisions are still guided by the dichotomy of limited versus extensive. Limited-stage patients get chemo-radiotherapy, and extensive-stage patients are treated primarily with systemic therapy. So even though we talk about stages I through IV, this clear division guides treatment.
4) If my scans show no visible cancer after treatment, am I considered cured or just in remission?
Dr. Rudin: We would consider that patient to be in remission, not necessarily cured. SCLC is highly responsive to treatment, so we often see dramatic shrinkage, even to the point where disease is undetectable. Some of these patients might ultimately be cured, but we monitor everyone closely for recurrence or progression. Unfortunately, patients are at high risk of recurrence after initial successful therapy.
5) Are there biological or genetic differences that explain why some patients respond to treatment and others don’t?
Dr. Rudin: This is an area of ongoing investigation. We don’t have great biomarkers to predict who will be a long-term survivor. The best predictors we have are fairly simple things, like performance status, how healthy and active a patient is going into therapy. Can they do daily activities, exercise, get out of the house?
We also look at lab values, like LDH, which can correlate with better outcomes, and the absence of brain or liver metastases also correlates with better outcomes. But these are not definitive. So we usually approach the disease with curative intent if possible, while recognizing it’s still aggressive and, for many patients, unfortunately lethal.
Watch the full webinar replay here or visit part 2 of the webinar recap where Dr. Rudin explains SCLC treatment options and side effects.
