Can consolidative thoracic radiotherapy improve outcomes in extensive-disease small cell lung cancer after chemotherapy with complete/near-complete responders?

Background: In extensive-disease-small cell lung cancer (ED-SCLC), the median survival is 8–10 months and 2-year survival is <5%. Primary tumor progression occurs in 90% of patients approximately within 1 year. The role of consolidative thoracic radiotherapy (C-TRT) for the postchemotherapy residue with the aim of improving local control (LC) and survival is currently of great interest. The objective of this study is to determine the effectiveness of C-TRT on LC, progression-free survival (PFS), and overall survival (OS) in ED-SCLC. Materials and Methods: Medical records of patients diagnosed as SCLC between January 2010 and December 2015 were evaluated retrospectively. Patients who received C-TRT were identified. Pre- and post-chemotherapy radiological evaluations, radiotherapy schedules, relapse patterns, toxicity incidence, LC, PFS, and OS were analyzed. Results: Among 552 SCLC patients, 26 ED-SCLC patients who underwent C-TRT were analyzed. Median follow-up was 7.5 months (range, 6.5–8.5 months). Nearly 50% of the patients had >4 metastatic lesions. Restaging was performed mostly by positron emission tomography/computed tomography and cranial magnetic resonance imaging. All patients had complete or near-complete response distantly. C-TRT was 10 × 300 cGy (n = 1), 23 × 200 cGy (n = 2), 25 × 200 cGy (n = 7), 30 × 200 cGy (n = 12), and 33 × 200 cGy (n = 4). There was no toxicity ≥ Grade 3. LC rate was 77%; there was no isolated local relapse. PFS was 3 months. Median survival was 13 months. The 1- and 2-year OS rates were 62% and 8%, respectively. Conclusion: In ED-SCLC patients, C-TRT may prevent isolated local recurrence and may improve 1-year survival. This survival improvement might be the reflection of high intrathoracic control achieved in 77% of patients

Combined chemotherapy of irinotecan/platinum in extensive disease SCLC / 实用肿瘤学杂志

Small cell lung cancer(SCLC),characterized with rapid growth and early metastasis ,accounts for about 15~20 percent of all kinds of lung cancer .Patients with extensive disease of SCLC should be treated with combined chemotherapy .The standard treatment for extensive SCLC is etoposide combined with platinum , shortly for EP,with no breakthrough progress in the last decades .This paper briefly reviews the combination of iri-notecan/platinum that showed effectiveness and safety in the treatment of extensive SCLC .

Belotecan and Cisplatin Combination Chemotherapy for Previously Untreated Extensive-Disease Small Cell Lung Cancer

PURPOSE: Belotecan (Camtobell(R); Chong Keun Dang Co., Seoul, Korea) is a new camptothecin analog that inhibits topoisomerase I. We evaluated the efficacy and toxicity of belotecan combined with cisplatin in patients with previously untreated extensive-disease small cell lung cancer (ED-SCLC) and who were without evidence of brain metastases. MATERIALS AND METHODS: Twenty patients with previously untreated ED-SCLC were treated with belotecan (0.5 mg/m2/day) on days 1~4 and with cisplatin (60 mg/m2/day) on day 1 of a 3-week cycle. RESULTS: Of the 19 assessable patients, 16 had an objective tumor response, including two complete responses, for an overall response rate of 84.2%. Toxicity was evaluated in all 20 patients who received a total of 106 cycles (median cycles/patient, 5.5; range, 1~9). The major grade 3/4 hematologic toxicities were neutropenia (67.9% of cycles), anemia (19.8% of cycles) and thrombocytopenia (33.9% of cycles). No grade 3/4 non-hematologic toxicities were observed. No treatment-related deaths occurred. The median progression-free and overall survivals were 7.06 months (95% confidence interval [CI], 3.98~10.14 months) and 9.96 months (95% CI, 6.12~13.80 months), respectively. CONCLUSION: Combination chemotherapy with belotecan plus cisplatin is an effective treatment for ED-SCLC with acceptable hematologic and non-hematologic toxicities.

Phase II study of cyclophosphamide, doxorubicin, and vincristine (CAV) and etoposide plus cisplatin (EP) alternating chemotherapy combined with radiotherapy in small cell lung cancer

The development of drug resistance is the major limiting factor influencing the survival of patients with small cell lung cancer (SCLC). We have thus examined the activity of cyclophosphamide, doxorubicin and vincristine (CAV) alternating with etoposide and cisplatin (EP) in 35 patients with SCLC. The treatment courses were alternated every 3 or 4 weeks. After induction chemotherapy, patients with limited disease (LD) received thoracic radiotherapy (5000 cGy), prophylactic cranial irradiation (3000 cGy) and maintenance chemotherapy and patients with extensive disease (ED) received maintenance chemotherapy only. In this group of 35 patients, 13 had limited disease (LD) and 22 had extensive disease (ED). After completion of the therapy, 100% of the patients with LD achieved complete plus partial remission (CR + PR) and 68% of the patients with ED achieved CR + PR. The median survival time was 66 weeks (15.3 months) in patients with LD and 44 weeks (10.2 months) in patients with ED. The over all survival for patients with LD was superior to that for patients with ED (p less than 0.05). Also, median response duration for patients with LD (35 wks) was longer than that for patients with ED (17 weeks) (p less than 0.05). The primary site was the most vulnerable site to relapse (18 patients). Toxicity was mild to moderate and acceptable, and there were no treatment-related deaths. These results suggest that the alternation of CAV and EP is effective treatment strategy in the management of SCLC. A randomized controlled study will be required to discriminate the actual effect of this alternating regimen.