Cancer bronchique à petites cellules : traitements de première ligne et maintenance

Abstract

Among all kind of lung cancer, small-cell lung cancer (SCLC) has a particular role. Nowadays, SCLC is epidemiologically declining and the idea that this cancer would disappear while remaining undefeated may be read everywhere in the medical literature. Yet, there are still progress made to optimize the initial therapy and the next chapters aims at summarizing them.First, we present the main arguments that led to the algorithm used nowadays. If there is something for sure, the first steps of SCLC care are critical in terms of prognostic. As a result, the initial care of SCLC is crucial, and has to be quick and optimal, even more than in non-small cell lung cancer. Whatever the stage, a sub-optimal first-line chemotherapy seriously compromises the chances of survival at 2 years. Concerning limited stage, thoracic radiotherapy begun within thirty days after the first administration of chemotherapy has better results than irradiation delivered later (also than sequential radiotherapy).Finally, this article describes new perspectives: clinicians expect a lot from the analysis of genotypic alterations in SCLC. A few steps have been made and a new target is already known: DLL3 (Delta Like Protein 3), which is NOTCH ligand. If anti-angiogenic therapies’ influence is too weak to go on trying in this direction, immunotherapies, using modern immuno-oncologic treatment, are still giving some hope. But let’s remain careful because these therapies are still on development and studies are going on.