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Salvage treatment with topotecan in patients with irinotecan-refractory small cell lung cancer

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Abstract

Purpose

Although the efficacy of topotecan as a second-line chemotherapy for small-cell lung cancer (SCLC) has been consistently demonstrated in phase II/III clinical trials, the choice of irinotecan as the first-line therapy prevented the use of evidence-based option. This pilot study was conducted to determine the activity and safety of topotecan in SCLC patients refractory to first-line therapy with irinotecan and platinum.

Methods

Patients with primary refractory (no response, or progression during or ≤90 days after last chemotherapy) SCLC after treatment with a combination of irinotecan and platinum, received topotecan 1.5 mg/m2 per day as a 30-min infusion daily for 5 days, every 3 weeks.

Results

Of 17 eligible patients, ten patients were previously treated with irinotecan plus cisplatin and 7 were treated with irinotecan plus carboplatin. The median age was 68 years (range 44–75) and the median interval from the last chemotherapy was 50 days (range 21–89). A total of 33 chemotherapy cycles were delivered (median 2; range 1–5). All 17 patients discontinued therapy due to disease progression and 5 patients had progressive disease before second cycle. Toxic effects were mainly hematologic (grade ≥3 neutropenia in 65% of patients) and fatigue (grade 3 in 47%). In an intent-to-treat analysis, two (12%) patients had a confirmed partial response and two patients achieved stable disease. Median progression-free and overall survivals were 1.7 months (95% CI, 1.5–1.9) and 3.4 months (95% CI, 1.7–5.0), respectively.

Conclusions

Topotecan monotherapy for patients with irinotecan-refractory SCLC does not appear highly active but the observation of some responses merits further study in patients with chemosensitive disease.

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Authors and Affiliations

  1. Department of Internal Medicine, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea

    Se Hoon Park

  2. Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea

    Eun Kyung Cho, Yujin Kim, Sun Young Kyung, Chang Hyeok An, Sang Pyo Lee, Jeong Woong Park, Sung Hwan Jeong, Jinny Park, Dong Bok Shin & Jae Hoon Lee

  3. Department of Thoracic Surgery, Gachon University Gil Medical Center, Incheon, South Korea

    Jae-Ik Lee

  4. Department of Radiology, Gachon University Gil Medical Center, Incheon, South Korea

    Soo Jin Choi

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  1. Se Hoon Park
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  2. Eun Kyung Cho
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Correspondence to Eun Kyung Cho.

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Park, S.H., Cho, E.K., Kim, Y. et al. Salvage treatment with topotecan in patients with irinotecan-refractory small cell lung cancer. Cancer Chemother Pharmacol 62, 1009–1014 (2008). https://doi.org/10.1007/s00280-008-0690-1

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  • DOI: https://doi.org/10.1007/s00280-008-0690-1

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