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Treatment of Small Cell Lung Cancer |
Lung Cancer Update Issue 4, 2008
DR ETTINGER: In the SWOG-S0124
trial, which compared front-line
irinotecan/cisplatin to etoposide/cisplatin
in patients with extensive-stage
SCLC, no efficacy advantage was
observed with the irinotecan regimen
and far more diarrhea occurred. A first-line
study evaluated topotecan/cisplatin
versus etoposide/cisplatin again, with
no difference. So in my opinion, why
use topotecan/cisplatin when etoposide/cisplatin is less toxic?
Lung Cancer Update Issue 4, 2008
DR SANDLER: Mark Socinski conducted
a Phase III trial comparing pemetrexed/carboplatin to etoposide/carboplatin in
extensive-stage SCLC. The interim data
presented at ASCO showed a statistically
significant difference favoring the
etoposide/carboplatin arm. So clear-cut
evidence exists not to use pemetrexed/carboplatin.
Lung Cancer Update Issue 1, 2008
DR WOZNIAK: Topotecan is approved
for second-line therapy in SCLC. I
find that this agent is sometimes of
value, but it’s difficult to administer
second-line because of the hematologic
side effects. Approval was based on a
trial in which it was administered for
five consecutive days and, in my opinion,
these patients can’t tolerate it. I believe
this is fertile ground for evaluating other
drugs active in SCLC.
Lung Cancer Update Issue 3, 2007
DR BRUCE E JOHNSON: The study by
Slotman and colleagues of prophylactic
cranial irradiation in patients with
extensive-stage SCLC builds on
previously published data. Most of the
clinical research that has evaluated
prophylactic cranial radiation has been
for patients with limited-stage disease.
Click on the image to enlarge
Lung Cancer Update Issue 4, 2008
DR ETTINGER: In the SWOG-S0124
trial, which compared front-line
irinotecan/cisplatin to etoposide/cisplatin
in patients with extensive-stage
SCLC, no efficacy advantage was
observed with the irinotecan regimen
and far more diarrhea occurred. A first-line
study evaluated topotecan/cisplatin
versus etoposide/cisplatin again, with
no difference. So in my opinion, why
use topotecan/cisplatin when etoposide/cisplatin is less toxic?
Lung Cancer Update Issue 4, 2008
DR SANDLER: Mark Socinski conducted
a Phase III trial comparing pemetrexed/carboplatin to etoposide/carboplatin in
extensive-stage SCLC. The interim data
presented at ASCO showed a statistically
significant difference favoring the
etoposide/carboplatin arm. So clear-cut
evidence exists not to use pemetrexed/carboplatin.
Lung Cancer Update Issue 1, 2008
DR WOZNIAK: Topotecan is approved
for second-line therapy in SCLC. I
find that this agent is sometimes of
value, but it’s difficult to administer
second-line because of the hematologic
side effects. Approval was based on a
trial in which it was administered for
five consecutive days and, in my opinion,
these patients can’t tolerate it. I believe
this is fertile ground for evaluating other
drugs active in SCLC.
Lung Cancer Update Issue 3, 2007
DR BRUCE E JOHNSON: The study by
Slotman and colleagues of prophylactic
cranial irradiation in patients with
extensive-stage SCLC builds on
previously published data. Most of the
clinical research that has evaluated
prophylactic cranial radiation has been
for patients with limited-stage disease.
It has been shown to reduce the risk of
brain metastases and prolong survival for
patients who achieved a complete response
to chemotherapy. In this particular study,
they accrued 286 patients with extensive-stage disease who demonstrated a
response to chemotherapy and randomly
assigned them to one of several different
doses of prophylactic cranial radiation.
The primary endpoint was a reduction
in the risk of developing brain metastases,
which was impressively positive in
that the hazard ratio of developing brain
metastases decreased to approximately
0.27. An approximately threefold reduction
occurred, which was impressive.
What was even more impressive was that
the risk of dying was reduced to a hazard
ratio of 0.68, a reduction of more than
30 percent.
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