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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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