88 Oral etoposide (VP-16) every 3 wks. or continuously to elderly patients with small cell lung cancer (SCLC): Preliminary results of a randomized study

Bork, E.; Hirsch, F. R.; Jeppesen, Nina; Lassen, Ulrik; Vallentin, Susanne; Østerlind, Kell; Mejer, J.; Ingeberg, Steen; Bergman, Bengt; Dombernowsky, P

doi:10.1016/s0169-5002(97)89367-1

Cited by 6 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…If patients with other poor prognostic factors had been excluded, the results might have been in favour of treatment intensification. Epipodophyllotoxins can safety be administered to elderly patients (Bork et al, 1991(Bork et al, , 1997. The risk of toxic death is correlated to dose intensity and scheduling with other agents.…”

Section: Discussionmentioning

confidence: 99%

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression

et al. 1999

View full text Add to dashboard Cite

Based on an increased frequency of early death (death within the first treatment cycle) in our two latest randomized trials of combination chemotherapy in small-cell lung cancer (SCLC), we wanted to identify patients at risk of early non-toxic death (ENTD) and early toxic death (ETD). Data were stored in a database and logistic regression analyses were performed to identify predictive factors for early death. During the first cycle, 118 out of 937 patients (12.6%) died. In 38 patients (4%), the cause of death was sepsis. Significant risk factors were age, performance status (PS), lactate dehydrogenase (LDH) and treatment with epipodophyllotoxins and platinum in the first cycle (EP). Risk factors for ENTD were age, PS and LDH. Extensive stage had a hazard ratio of 1.9 ( P = 0.07). Risk factors for ETD were EP, PS and LDH, whereas age and stage were not. For EP, the hazard ratio was as high as 6.7 ( P = 0.0001). We introduced a simple prognostic algorithm including performance status, LDH and age. Using a prognostic algorithm to exclude poor-risk patients from trials, we could minimize early death, improve long-term survival and increase the survival differences between different regimens. We suggest that other groups evaluate our algorithm and exclude poor prognosis patients from trials of dose intensification. © 1999 Cancer Research Campaign

show abstract

Section: Discussionmentioning

confidence: 99%

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression

et al. 1999

View full text Add to dashboard Cite

show abstract

“…Per oral etoposide 200 mg?m -2 5 days every 3 weeks resulted in a similar response rate (62%), but both response duration and median survival were three months shorter. The 2-yr survival was 7% [73]. Two trials comparing p.o.…”

Section: Elderly Patientsmentioning

confidence: 98%

“…In other words: a more active approach and uniform handling of elderly patients, including treatment regimens especially designed for this category of patients, are warranted. Ten-years-ago single-agent regimes with etoposide per orally were investigated as candidates for treatment of elderly SCLC patients [69][70][71][72][73]. Given intraveneously in a dosage of 100 mg?m -2 for 5 days every 3 weeks BORK et al [71] obtained CR or PR in 65% of the patients, the median survival was 10.6 months and 2-yr survival 8%.…”

Section: Elderly Patientsmentioning

confidence: 99%

Chemotherapy in small cell lung cancer

Østerlind¹

2001

Eur Respir J

View full text Add to dashboard Cite

Chemotherapy is the backbone in the treatment of small cell lung cancer (SCLC) and radiotherapy is an important adjunct in limited stage disease. The role of chest irradiation is now documented in three meta-analysis, based on the same body of data. Trials on timing, scheduling and fractionation could have followed a more stringent development line but altogether, the highest efficacy seems to be obtained with early, concurrent twice-daily chest irradiation. Patients in complete remission should have prophylactic cranial irradiation, which reduces the risk of brain metastases and of death from SCLC.Four series of chemotherapy seem to be sufficient in limited-stage disease while six is recommended in extensive disease. The combination of etoposide plus cis- or carboplatin is appropriate in both stages and addition of other agents has no clinically important impact on the survival. Use of haematological growth factors such as granulocyte colony stimulating factor (G-CSF) and granulocyte macrophage colony stimulating factor (GM-CSF) may enable higher doses or more frequent dosage. Three randomized trials on GM-CSF showed a negative outcome while G-CSF support may result in better survival rates, but a more cost-efficient policy must be found. High-dose chemotherapy plus haematological stem-cell support is still under investigation but disappointing long-term survival rates means there is not much optimism for this strategy.New strategies in general are requested in the treatment of extensive-stage disease and of elderly patients. Phase II trials suggest that good-risk patients with extensive disease should be treated aggressively, intermediate-risk patients more gently, and palliation must be the primary aim in the treatment of poor-risk patients. In elderly patients impressive survival rates are obtained with 3–4 series of chemotherapy and radiation delivered in 5–10 fractions.A number of new agents are active but more trials are required before each has found a place, if any, in the treatment of small cell lung cancer. To conclude, the randomized trial is still an important instrument in clinical oncology, and trials in small cell lung cancer must be large, which is why the cooperation of organizations and multicentres is urgent.

show abstract

“…Oral etoposide has been largely used as single-drug chemotherapy. Five phase II studies [73][74][75][76][77] showed RRs of 53%-84% with an MST ranging from 4.6-16 months. This treatment is generally well tolerated.…”

mentioning

confidence: 99%

“…This treatment is generally well tolerated. Bork et al [77] randomized elderly SCLC patients to receive one of two different schedules of oral etoposide (continuous treatment versus every 3 weeks) and reported no statistical differences in terms of RR and OS. However, the use of singleagent oral etoposide decreased dramatically after the release of the results from two randomized trials [78,79].…”

mentioning

confidence: 99%

Treatment of Small Cell Lung Cancer in the Elderly

et al. 2005

View full text Add to dashboard Cite

Small cell lung cancer (SCLC) accounts for approximately 20% of lung carcinomas. Chemotherapy is the cornerstone of treatment for SCLC. In limited disease, the median survival time is about 12-16 months, with a 4%-5% long-term survival rate; in extensive disease the median survival time is 7-11 months. More than 50% of lung cancer patients are diagnosed when they are over the age of 65, and about 30% are over 70. Elderly patients tolerate chemotherapy poorly compared with their younger counterparts, because of agerelated progressive reductions in organ function and comorbidities. The standard therapy for limited disease is combined chemoradiotherapy, followed by prophylactic brain irradiation for patients achieving complete responses. In the elderly, the addition of radiotherapy to chemotherapy must be carefully evaluated, considering the slight survival benefit and potential for substantial toxicity incurred with this treatment. The best approach is to design clinical trials that specifically include geriatric assessment to develop active and well-tolerated chemotherapy regimens for elderly SCLC patients. Survival improvement for SCLC patients requires a better understanding of tumor biology and the subsequent development of novel therapeutic strategies. Several targeted agents have been introduced into clinical trials in SCLC, but a minority of these new agents offers a promise of improved outcomes, and negative results are reported more commonly than positive ones. This review focuses on the main issues in the treatment of elderly SCLC patients. The Oncologist 2005;10:399-411The Oncologist 2005;10:399-411 www.TheOncologist.com

show abstract

88 Oral etoposide (VP-16) every 3 wks. or continuously to elderly patients with small cell lung cancer (SCLC): Preliminary results of a randomized study

Cited by 6 publications

References 0 publications

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression

Early death during chemotherapy in patients with small-cell lung cancer: derivation of a prognostic index for toxic death and progression

Chemotherapy in small cell lung cancer

Treatment of Small Cell Lung Cancer in the Elderly

Contact Info

Product

Resources

About