However, over the last 30 years there has been a distinct paucity of significant breakthroughs in SCLC therapy. Thus, SCLC is characterized as a recalcitrant neoplasm with limited therapeutic options. By employing well-established research approaches, proven to be efficacious in non-small cell lung cancer (NSCLC), a growing amount of data has shed light on the molecular biology of SCLC and enhanced our knowledge of the “drivers” of tumor cell survival and proliferation.
New therapeutic targets have emerged, but no significant improvement in patients’ survival has been demonstrated thus far.
In a sense, the more we know, the more we fail.
Nowadays this is starting to change and methodical research efforts are underway. It is anticipated that the next decade will see a revolution in the treatment of SCLC patients with the application of effective precision medicine and immunotherapy strategies.
In spite of recent advances in elucidating the aberrant molecular pathways that dictate SCLC oncogenesis, this malignancy remains an important public health problem, leading to the death of approximately 16,000 patients per year in the United States (14). For decades, cytotoxic chemotherapy has remained the backbone of treatment but, while SCLC is a chemo-sensitive disease, experience shows that high response rates are not universally translated into a cure. Nevertheless, it is high time progress was made in SCLC research and we have all the necessary tools at our disposal. Every failure is a lesson learnt, every success a battle fought. Our aim must be to improve the prognosis of patients with SCLC.
We are still on the long journey to Ithaca and should not let the Sirens of excessive optimism distract us from our goal. With determination and cunning we can reach Ithaca. By any means, whatever the final result may be, the entire research process will make us wiser.
“As you set out for Ithaca, hope the voyage is a long one, full of adventure, full of discovery……And if you find her poor, Ithaca won’t have fooled you. Wise as you will have become, so full of experience, you will have understood by then what these Ithakas mean” (The Canon by CP Cavafy, translated by Edmund Keeley and Philip Sherrard).