Chemotherapy for small cell lung cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells.
Small cell lung cancers often respond well to chemotherapy. Treatment can improve symptoms such as breathlessness, coughing, coughing up blood and chest pain.
If your cancer can’t be cured, chemotherapy can help you to live longer with fewer symptoms.
How chemotherapy is given
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You may have your chemotherapy in the outpatient department, or you may be given tablets to take at home. Sometimes you may need to spend a night or two in hospital to have your treatment.
The drugs are given by injection into a vein (intravenously) or sometimes as tablets (orally). Each session of chemotherapy may last a few days, followed by a rest period of a few weeks. This is known as a cycle of treatment. The number of cycles you have will depend on how well the cancer is responding to the treatment.
Doctors are always looking to improve the treatment of lung cancer, so you may be asked to take part in a clinical trial.
The drugs that are used
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The most commonly used drugs to treat small cell lung cancer are cisplatin or carboplatin; often in combination with etoposide (Etopophos®, Vepesid®).
However, many different combinations of drugs have been used in the treatment of small cell lung cancer, and clinical trials have shown that they all appear to be equally effective. So the exact drugs used and timings of treatment vary.
If small cell lung cancer comes back after initial treatment, chemotherapy may be recommended again. Your doctors may offer you the drugs you had last time, depending on how you responded to them and how long it’s been since you finished the treatment.
Other drugs that are sometimes used in this situation are combinations of doxorubicin, cyclophosphamide and etoposide (known as ACE); or a combination of cyclophosphamide, doxorubicin and vincristine (Oncovin®) (CAV) may also be used. The chemotherapy drug topotecan (Hycamtin®), which is available as a drip (infusion) or as a capsule may also be used.
Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be controlled well with medicine. Some main side effects are described here along with some of the ways they can be reduced.
Risk of infection
This treatment can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you’ll be more prone to infections. A low white blood cell count is called neutropenia.
This begins seven days after treatment and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You’ll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising or bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless.
You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting.
If the sickness isn’t controlled or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening.
Some people find sucking on ice soothing.
This usually starts 3-4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished.
We have more information about coping with hair loss.
Numbness or tingling in the hands or feet
This is due to the effect of some drugs on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. This side effect usually improves slowly, a few months after the treatment has finished. But sometimes symptoms can persist.
Changes to your hearing
You may have ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment.
Any hearing loss, and balance changes if they occur, may be permanent. However, tinnitus usually improves when treatment ends.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise such as short walks.
Chemotherapy affects different people in different ways. Some people are able to lead a normal life during their treatment; others find they become very tired and have to take things more slowly.
Although they may seem hard to bear at the time, any side effects you have are usually temporary and will disappear once your treatment is over.
Some people feel better during their chemotherapy treatment as it can help to ease symptoms they’ve been living with.