Targeting angiogenesis in small cell lung cancer

Small cell lung cancer (SCLC) constitutes approximately 15% of lung cancers and is strongly associated with smoking (1). The prognosis of this cancer is dismal due to frequent disseminated disease at detection and rapid appearance of chemoresistant relapses after assumed successful first-line chemotherapy (2,3). Standard therapy consists of a combination of cisplatin/carboplatin and etoposide resulting in high initial response rates which are not durable and are followed by recurrences within approximately 1 year. The relapsing tumors are highly chemoresistant and are treated with topotecan or a CAV regimen (cyclophosphamide/adriamycin—replaced by epirubicin/vincristine) which yield low response rates of short duration at best. Patients with limited disease SCLC (LDSCLC) have a median survival time of 16–24 months when treated with chemotherapy but extended disease SCLC (EDSCLC) reduces the median survival to 7–12 months (4,5). Prophylactic cranial irradiation (PCI) in chemotherapyresponsive patients decreases the risk of brain metastases and increases overall survival (OS) (6).