Treatment of extensive stage small cell lung cancer

Small-cell lung cancer: an update on targeted therapies

Lung cancer is the leading cause of cancer-related deaths world-wide and small-cell lung cancer (SCLC) accounts for up to 25% of lung cancer deaths. There has been a considerable amount of research in the understanding of the depth of biology of SCLC and utilizing this knowledge to develop targeted approaches. The treatment of SCLC remains a challenge, despite remarkable initial efficacy to combination chemotherapy and radiation therapy. The response is usually short-lived and the prognosis of SCLC has not changed over the past few decades, necessitating the critical need for evaluating novel agents/therapies. Several signaling pathways have been found to be activated in SCLC tumor cells, forming a rationale for blocking some of the drugable targets. Molecular changes and biological markers have been identified but remain to be validated. Novel and targeted agents have been evaluated but without much success. Increasing understanding of the biology and potential clinical evaluation of biomarkers will pave the way for more effective treatments.

The future of cyclooxygenase-2 inhibitors and other inhibitors of the eicosanoid signal pathway in the prevention and therapy of lung cancer

Recent advances in the understanding of the biology and molecular biology of lung cancer has provided targets for novel therapeutic and chemoprevention strategies. The eicosanoid/prostaglandin signal pathway is involved in the metabolism of membrane phospholipids to end products that are involved in apoptosis, proliferation, differentiation, and angiogenesis. Abnormalities in this pathway occur frequently in lung cancer, including the overexpression of cytoplasmic phospholipase A2, cyclooxygenase-2 (COX-2), prostaglandin E (PGE) synthase, PGE2, 5-lipoxygenase (LOX), 8-LOX, and 12-LOX. Increased levels of PGE2, 5-LOX, 8-LOX, and 12-LOX promote tumor proliferation and angiogenesis and inhibit apoptosis. On the other hand, levels of proapoptotic, antiangiogenic, and antiproliferative products are frequently decreased in lung cancer due to decreased levels of enzymes such as prostacyclin synthase. These abnormalities provide a rationale for the use of inhibitors of overexpressed enzymes or replacement of anticarcinogenic end products, and such agents have been studied in preclinical and clinical trials.