Small cell lung cancer spreads quickly from the lungs to other parts of the body. For most people, chemotherapy is part of the primary treatment. It usually is given with immunotherapy or radiation therapy.

The approach your MSK doctors recommend will depend on the stage of your disease. Small cell lung cancer is at a limited stage if it can be treated with radiation in 1 area. That usually means it is in 1 lung, or maybe only on 1 side of the chest. The cancer is at an extensive stage if it has spread widely. Most people are at the extensive stage when small cell lung cancer is diagnosed.

• People with limited-stage small cell lung cancer get chemotherapy and radiation therapy at the same time to shrink the tumor.
• People with extensive-stage cancer usually get chemotherapy with immunotherapy. Radiation therapy is very targeted. It does not work well when the cancer has spread from the lung to other parts of the body. Radiation therapy may help some people. It can improve symptoms or stop the cancer from spreading to the brain. 

For almost everyone with small cell lung cancer, the first chemotherapy includes the drug etoposide. It’s given with a platinum agent, either cisplatin or carboplatin.

After this first treatment, the cancer may continue to grow, or it can return. There are 2 approved chemotherapy drugs for this, as well as immunotherapy. MSK is always looking for new therapies for cancer that returned after standard treatment.

New Drug Approaches

For many people, the best treatment plan is to join a clinical trial that tests new drugs. These research studies test drugs either alone or together with more standard treatments.

We are testing several new treatments for small cell lung cancer. Some use an antibody to target a chemotherapy drug specifically to tumor cells. Other drugs target growth pathways. Several of these new treatments show early promise.

We also are researching what makes small cell lung cancer grow and spread. Our focus is on molecular factors, such as proteins, DNA, and RNA. Our goal is to stop cancer from growing by developing targeted therapies for specific molecules.

For non-small cell lung cancer tumors that can be removed with surgery, we give chemotherapy before or after surgery. Even tumors completely removed during surgery or killed by radiation therapy can return. This happens if microscopic (very tiny) cancer cells travel from the primary tumor to other areas. Our medical oncologists will work closely with your surgeon. They will decide if adding chemotherapy to your treatment plan before or after surgery may give you a better result.

Some people have non-small cell lung cancer with tumors that already have spread at the time of diagnosis. If the cancer spread locally in the chest, we may recommend chemotherapy with radiation therapy. If it spread to other areas in the body, we may recommend chemotherapy alone, or with immunotherapy.

In recent years, drugs have targeted specific genetic abnormalities (problems in the genes) in lung cancer cells. Lung cancer can have a “driver mutation.” This change in the genes causes the cancer to grow or spread. If so, we may recommend treatment with targeted therapy drugs aimed right at the mutation. For example, patients with an EGFR mutation generally respond well to treatment with the drug osimertinib (Tagrisso^®). If the tumor has a genetic abnormality in a gene called ALK, the drug alectinib (Retevmo^®) may help.

One exciting new targeted therapy is the drug sotorasib (Lumakras^TM). It is for advanced non-small cell lung cancer tumors that have a driver mutation called KRAS-G12C. KRAS mutations fuel cancer growth and may cause 1 out of 4 cases of lung cancers. But for decades, they were considered an “undruggable” target. MSK researchers and doctors played a leading role in clinical trials that led to sotorasib’s approval in 2021.

Another exciting advance has been the use of immunotherapy agents, including pembrolizumab (Keytruda^®), nivolumab (Opdivo^®), durvalumab (Imfinzi^®), and atezolizumab (Tecentriq^®). These drugs stimulate the immune system, helping it recognize and fight cancer. We may suggest using them alone or with chemotherapy. MSK doctors led many of the important research studies about the use of immunotherapy for cancer.

From the lungs, the first place cancer cells often spread to is the lymph nodes (also called lymph glands). This is because the lymph nodes act as a filter, trapping cancer cells as they travel from the lungs.

Clinical studies led at MSK researched giving chemotherapy before surgery. These studies showed this approach can improve cure rates when non-small cell lung cancer has spread to lymph nodes. Chemotherapy before surgery is called neoadjuvant chemotherapy. It involves giving chemotherapy for several months before surgery. In some cases, cancer cells in the lymph nodes can be completely killed off before surgery.

Neoadjuvant chemotherapy has doubled the cure rate for people with stage 3 non-small cell lung cancer. It has cured people with some forms of lung cancer who would not have been cured by surgery alone.

Because of this success, MSK doctors continue to test this approach using newer drug therapies, including immunotherapy. We also offer neoadjuvant chemotherapy to people with larger tumors that have not spread to the lymph nodes. These tumors have a high risk of returning, even after successful surgery.

Another approach is to give chemotherapy after surgery, called adjuvant chemotherapy. Whether your doctor recommends this technique depends on a variety of factors, including the size of your tumor. Adjuvant chemotherapy is often prescribed when the cancer cells have spread to the lymph nodes. Traditional adjuvant chemotherapy can help you to live longer and improves your chance for a cure.