Chemotherapy for small cell lung cancer

Why chemotherapy is given Back to top

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs work by disrupting the growth of cancer cells.

Small cell lung cancers often respond well to chemotherapy. Treatment can improve symptoms such as breathlessness, a cough, 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 Back to top

The drugs are given by injection into a vein (intravenously) or sometimes as tablets (orally). Each cycle of chemotherapy may last a few days. After having chemotherapy you will have a rest period of a few weeks to allow your body to recover from any side effects. The number of cycles you have will depend on how well the cancer is responding to the treatment.

You may have your chemotherapy in the outpatient department or be given tablets to take at home. Sometimes you may need to spend a night or two in hospital to have your 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 used Back to top

There are over 60 different chemotherapy drugs. Those most commonly used to treat small cell lung cancer are cisplatin|  or carboplatin| often in combination with etoposide| (VP-16, Etopophos®, Vepesid®). A combination of cyclophosphamide, doxorubicin and vincristine (Oncovin®) may also be used. This combination of chemotherapy drugs is known as CAV|.

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 timing of treatment vary.

If small cell lung cancer comes back after treatment, chemotherapy may be recommended again. The drugs that are sometimes used in this situation are combinations of doxorubicin|, cyclophosphamide| and etoposide| (known as ACE), or CAV. The chemotherapy drug topotecan| (Hycamtin®) which is available as a drip (infusion) or as a capsule may also be used.

Side effects  Back to top

Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be well controlled with medicine. The main side effects are described here, along with some of the ways they can be reduced.

Lowered resistance to infection (neutropenia) 

Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more likely to get an infection|. The number of white cells will usually have returned to normal before your next cycle of chemotherapy is due.

You should contact your doctor or the hospital straight away if your temperature goes above 38ºC (100.4ºF) or if you suddenly feel unwell, even with a normal temperature.

Bruising or bleeding

Chemotherapy can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells)

While having chemotherapy, you may become anaemic. This may make you feel tired and breathless|.

Feeling sick (nausea) 

There are now very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting|. Your doctor will prescribe these for you.

Sore mouth

Regular mouthwashes can help to keep your mouth clean and relieve any soreness|. Your nurse will show you how to use these properly.

Hair loss

Ask your doctor if the drugs you're taking are likely to make your hair fall out. Most patients are entitled to a free wig from the NHS and your doctor or nurse will be able to arrange this for you. Some people prefer to use hats or scarves. If your hair does fall out, it will grow back over a period of 3–6 months after the treatment ends.

We have more information about coping with hair loss|.

Tiredness (fatigue) 

You may feel very tired| and have a general feeling of weakness. It's important to allow yourself plenty of time to rest.

Chemotherapy affects people in different ways. Some find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it. 

Although they may be hard to bear at the time, these side effects will gradually disappear once your treatment is over.