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Combination of topotecan and etoposide as a salvage treatment for patients with recurrent small cell lung cancer following irinotecan and platinum first-line chemotherapy.

Choi HJ, Cho BC, Shin SJ, Cheon SH, Jung JY, Chang J, Kim SK, Sohn JH, Kim JH

Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-Gu, Shinchon-Dong 134, CPO Box 8044, Seoul 120-752, South Korea.

PURPOSE: The efficacy and safety of a combined regimen of topotecan and etoposide was tested in patients with relapsed or refractory small-cell lung cancer. PATIENTS AND METHODS: From October 2003 to May 2005, 23 patients who have failed to the previous irinotecan and platinum chemotherapy received intravenous topotecan 1 mg/m2 (day 1-5) and etoposide 80 mg/m2 (day 1-3). Treatment was repeated every 21 days for a maximum of 6 cycles. RESULTS: Twelve patients were refractory to first-line chemotherapy. Seventeen patients (73.9%) were male and the median age was 63 years. ECOG performance status was 0-1 in 13 (56.5%) patients. The median cycles of chemotherapy was three. Twenty-one patients were assessable for response evaluation. The overall response rate was 17.4% (0 CR, 4 PR, 7 SD, 10 PD) under the intent-to-treat analysis. Two sensitive case patients and two refractory case patients achieved partial response. After a median follow-up of 20.8 months, median progression free survival was 4.7 months and median overall survival was 9.5 months. The estimated 1-year survival rate was 38.7%. All patients were assessable for toxicity and major toxicities were myelosuppression. Grade 3/4 neutropenia and thrombocytopenia occurred in 18 (78.3%) and 12 (52.2%) patients, respectively. Grade 3/4 febrile neutropenia occurred in two patients (8.7%) and infection in three patients (13.0%). There was one treatment-related death due to pneumonia. CONCLUSION: This salvage regimen showed modest efficacy and manageable toxicities. Further study will be required in recurrent SCLC patients pretreated irinotecan and platinum.

Published 20 November 2007 in Cancer Chemother Pharmacol, 61(2): 309-13.
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