Common Challenges Faced While Treating SCLC


Gene G. Finley, MD, discusses the challenges that community oncologists are facing with small cell lung cancer treatment.

Gene G. Finley, MD, medical oncologist at Allegheny Clinic Medical Oncology of Allegheny Health Network, discusses the challenges that community oncologists are facing with small cell lung cancer (SCLC) treatment.

According to Finley, a major challenge in the SCLC is quick doubling time of tumor size. While solid tumors typically have a doubling time of 2 or 3 months, in SCLC, the size can double in just a few weeks.

As a result, Finley notes it is important to provide patients with therapy as early as possible as their disease can progress rapidly.


0:08 | One of the biggest challenges in small cell lung cancer is the rapid doubling time. While most human solid tumors have a clinical doubling time of between 2 and 3 months, small cell lung cancer is kind of unique in the solid tumor setting where the growth rate is akin to an aggressive non-Hodgkin lymphoma, where you can see doubling of tumor size in a couple of weeks.

0:38 | This creates a serious challenge, especially in the lung cancer space, because lung cancer patients tend to be very nihilistic because it may have been caused from smoking, they tend to be older, a more frail population, a smoking population, so they tend to have a lot of medical comorbidities, they tend to present at later stage. It's very important to institute therapy quickly in these patients. Even in patients who have poor functional status, you can have the sort of “Lazarus Effect” that we see in other aggressive malignancies where the growth fraction of the cell population is so high, that they have profound responses up to and including tumor lysis syndrome. That is the key thing with small cells, and with many non–small cells as well, is to institute therapy early.

1:47 | In SCLC, that's not really a problem generally, but if you have to wait to get the transition between an inpatient and outpatient setting, we have lost many patients in that transition over the years. We've taken to moving up the chemotherapy and trying to administer the first cycle of chemotherapy while the patient is still hospitalized because that's a much more facile way of getting their treatment going. Because of economic reasons and the way treatment is paid for in the United States, we can't really give them immunotherapy as an inpatient, but we can introduce it for the first cycle as an outpatient. I think that's 1 of the challenges that we have in the small cell space, the need to start chemotherapy early because the patients can progress and you can lose them so rapidly, particularly if they start out with a high volume of disease.

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