Chemotherapy for small-cell lung cancer: more is not better

 As have many other chemosensitive tumors, small-cell lung cancer (SCLC) has a well-documented chemotherapy dose-response relationship. However, a relationship between dose and survival has not yet been established. The effect of dose on survival should be examined in terms of both the dose used over a certain period (dose intensity) and the total dose of drugs employed, and neither the total dose of drugs used nor the duration of maintenance chemotherapy has been proven to provide an overall survival benefit. In the case of the dose-intensive approach there is no evidence for a significant survival benefit of either high-dose or dose-intensive weekly chemotherapy. Stem-cell support may be a promising means of increasing dose intensity, but the indications are limited and it should be considered highly experimental. Given the relatively good condition of patients in most comparative clinical trials, more is not better in chemotherapy for SCLC, at least in clinical practice.