Small Cell Lung Cancer (SCLC):
Less Common.
More Aggressive.

The 2 main classifications of lung cancer are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).1 They differ in many ways. Compared with NSCLC, SCLC has a poorer short-term prognosis and significantly lower overall survival (OS) rates.2-4

Unlike NSCLC, which has established biomarkers and may be identified by biopsy, SCLC is harder to diagnose. Not only does SCLC lack established biomarkers, a lack of adequate tissue samples from diagnostic biopsies makes it difficult for molecular profiling.4,5

  • SCLC is differentiated by a rapid doubling time, high growth fraction, and early development of widespread disease6,7
    • Although very responsive to initial treatment, the majority of patients will relapse with relatively resistant disease8

Primary Classifications and Proportion of Lung Cancer Cases2,9-11

Primary Classifications and Proportion of Lung Cancer Cases Pie Chart

aIn patients diagnosed between 2010 and 2016.

LOW SURVIVAL RATES PERSIST

  • SCLC survival has improved modestly over the past several decades11,14
    • The 5-year survival rate from 2010-2016 of 7% represents only a modest improvement from approximately 40 years ago, when it was 3.6%11
  • At the same time, treatments for SCLC have demonstrated improved efficacy.2 In each case, patient characteristics may influence the outcome in SCLC patients15

Factors Associated With SCLC Prognosis

  • NEGATIVE

    Poor performance status (3-4)8

    Extensive-stage disease8

    Weight loss8

    Markers associated with excessive bulk of disease (lactate dehydrogenase)8,15

  • FAVORABLE FOR LIMITED-STAGE DISEASE

    Female gender8,15

    Age <70 years8

    Normal lactate dehydrogenase8

    Stage I disease8

    Smoking cessation16

  • FAVORABLE FOR EXTENSIVE-STAGE DISEASE

    Younger age8

    Good performance status (0-1)8,15

    Normal creatinine level8

    Normal lactate dehydrogenase8,15

    Single metastatic site8

    Smoking cessation16

  • As understanding of SCLC grows, it may be possible to identify which patient characteristics point to more favorable outcomes15
  • Recent developments in SCLC therapies have shown promise for improved outcomes for appropriate patients2,17

Given the low rates of survival associated with SCLC, you may want to consider specific patient characteristics and prognostic factors when developing a treatment plan.

NCCN=National Comprehensive Cancer Network® (NCCN®)

    REFERENCES:
  1. What is lung cancer? American Cancer Society. https://www.cancer.org/cancer/lung-cancer/about/what-is.html. Accessed May 7, 2021.
  2. Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021;7(1):3. doi:10.1038/s41572-020-00235-0
  3. Lung cancer survival rates. American Cancer Society. https://www.cancer.org/cancer/lung-cancer/detection-diagnosis-staging/survival-rates.html. Accessed May 7, 2021.
  4. Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer. 2015;121(5):664-672.
  5. Villalobos P, Wistuba II. Lung cancer biomarkers. Hematol Oncol Clin North Am. 2017;31(1):13-29. doi:10.1016/j.hoc.2016.08.006
  6. Elias AD. Small cell lung cancer: state-of-the-art therapy in 1996. Chest. 1997;112(4):251S-258S.
  7. Huber RM, Tufman A. Update on small cell lung cancer management. Breathe. 2012;8(4):315-330.
  8. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.3.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed December 21, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  9. Basumallik N, Agarwal M. Small cell lung cancer. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan. https://www.ncbi.nlm.nih.gov/books/NBK430685/. Accessed May 7, 2021.
  10. Rossi A. Relapsed small-cell lung cancer: platinum re-challenge or not. J Thorac Dis. 2016;8(9):2360-2364.
  11. Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2017. National Cancer Institute. https://seer.cancer.gov/csr/1975_2017/. Accessed May 7, 2021.
  12. Key statistics for lung cancer. American Cancer Society. https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html. Accessed May 7, 2021.
  13. Pesch B, Kendzia B, Gustavsson P, et al. Cigarette smoking and lung cancer–relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer. 2012;131(5):1210-1219.
  14. Trigo J, Subbiah V, Besse B, et al. Lurbinectedin as second-line treatment for patients with small-cell lung cancer: a single-arm, open-label, phase 2 basket trial. Lancet Oncol. 2020;21(5):645-654.
  15. Foster NR, Mandrekar SJ, Schild SE, et al. Prognostic factors differ by tumor stage for small cell lung cancer: a pooled analysis of North Central Cancer Treatment Group (NCCTG) trials. Cancer. 2009;115(12):2721-2731.
  16. Albain KS, Crowley JJ, LeBlanc M, Livingston RB. Determinants of improved outcome in small-cell lung cancer: an analysis of the 2,580-patient Southwest Oncology Group data base. J Clin Oncol. 1990;8(9):1563-1574.
  17. Oronsky B, Reid TR, Oronsky A, Carter CA. What's new in SCLC? A review. Neoplasia. 2017;19(10):842-847.