Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial

Spiro, Stephen; Souhami, Robert L.; Geddes, Duncan M.; Ash, C. M.; Quinn, Hannah; Harper, Peter; Tobias, Jeffrey; Partridge, M; Eraut, D

doi:10.1038/bjc.1989.117

Cited by 160 publications

(56 citation statements)

References 8 publications

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“…This is in keeping with findings from a number of randomized trials that investigated duration of chemotherapy (Cullen et al, 1986;Medical Research Council Lung Cancer Working Party, 1989, 1993Spiro et al, 1989;Giaconne et al, 1993).…”

Section: Discussionsupporting

confidence: 79%

A national survey of the chemotherapy regimens used to treat small cell lung cancer (SCLC) in the United Kingdom

Sambrook

Girling

2001

Br J Cancer

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Many chemotherapy regimens are used for treating SCLC in the United Kingdom, but it is not known, in any detail, which regimens are used, by which specialists, for which types of patient. We conducted a survey among all medical and clinical oncologists, respiratory physicians and general physicians with respiratory interest in the United Kingdom to find out. The questionnaire asked for the number of SCLC patients treated annually; how many were given chemotherapy; the drugs, doses and schedules chosen according to prognostic group (as defined by the clinician); and the reasons for choice of regimen. 1214 questionnaires were sent out, and responses were received from 1070 (88%) clinicians; 266 (25%) of these treated SCLC with chemotherapy. Of 4674 patients given chemotherapy annually, 36% were given it by clinical oncologists, 30% by medical oncologists, 27% by respiratory physicians, and 7% by general physicians. In all, 34 regimens were reported with 151 different combinations of dose and schedule. In 2311 good prognosis patients, 23 regimens were used, the commonest being ACE (doxorubicin, cyclophosphamide, etoposide), ICbE (ifosfamide, carboplatin, etoposide), CAV (cyclophosphamide, doxorubicin, vincristine), CbE (carboplatin, etoposide), and PE (cisplatin, etoposide). In 1517 poor prognosis patients, 21 regimens were used, the commonest being CAV, EV (etoposide, vincristine), CbE, CAV alternating with PE, and oral etoposide. 452 patients were treated regardless of prognosis and for 219 no prognostic criteria were specified. The remaining 175 were given second-line chemotherapy or were given regimens chosen to avoid toxicity or because of intercurrent disease or other reasons. The main reasons affecting choice of regimen were routine local practice, patients' convenience, quality of life considerations, trial results and cost. The results show wide variation in routine practice and will be useful in reporting and planning clinical trials and in deciding on local treatment policies. © 2001 Cancer Research Campaign http://www.bjcancer.com

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Section: Discussionsupporting

confidence: 79%

A national survey of the chemotherapy regimens used to treat small cell lung cancer (SCLC) in the United Kingdom

Sambrook

Girling

2001

Br J Cancer

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“…5 In general, second-line chemotherapy is considered for cases with recurrent SCLC, and a few studies have reported on the efficacy of some second-line treatments. 6,7 For example, a prospective randomized trial comparing oral topotecan with best supportive care (BSC) revealed the benefits of treatment with oral topotecan in terms of the survival and quality of life. 7 Although some studies have shown the importance of both response and the duration of the response to initial chemotherapy in predicting the efficacy of second-line chemotherapy, [8][9][10] the number of studies conducted to identify the prognostic factors in recurrent SCLC patients is quite limited.…”

Section: Resultsmentioning

confidence: 99%

Performance status and sensitivity to first‐line chemotherapy are significant prognostic factors in patients with recurrent small cell lung cancer receiving second‐line chemotherapy

Kim

Goto

Yoh

et al. 2008

Cancer

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BACKGROUND To the authors' knowledge, the prognostic factors in recurrent small cell lung cancer (SCLC) patients treated with second‐line chemotherapy have not yet been clearly identified to date. METHODS Between July 1992 and December 2003, 232 of 515 patients who were diagnosed to have SCLC at the National Cancer Center Hospital East were administered second‐line chemotherapy for recurrent disease. The authors retrospectively analyzed the relation between clinical factors evaluated at the time of recurrence and the response to second‐line chemotherapy or survival in these patients. RESULTS The results of univariate analyses revealed that response was significantly associated with the performance status (PS) alone, whereas survival was significantly associated with the PS, disease extent, and sensitivity to first‐line chemotherapy. Multivariate analysis identified PS (P < .0001) and sensitivity to first‐line chemotherapy (P = .0024) as the independent prognostic factors for survival. When the patients were grouped according to these 2 significant prognostic factors, the survival of patients with a PS of 0 to 1 was significantly better than that of the patients with a PS of 2 to 4 both among cases that were sensitive and those that were refractory to first‐line chemotherapy. Although the survival of sensitive recurrent cases was significantly better than that of the refractory recurrent cases among the patients with a PS of 0 to 1 patients, no survival difference was observed between the sensitive and refractory recurrent cases in the patients with a PS of 2 to 4. CONCLUSIONS Both PS and sensitivity to initial chemotherapy were found to be significant prognostic factors for survival in recurrent SCLC patients treated with second‐line chemotherapy. These 2 factors should therefore be used as stratification factors in future clinical trials. Cancer 2008. © 2008 American Cancer Society.

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“…Chemotherapy response rates of greater than 80% are obtained in previously untreated patients (Klastersky et al, 1982;Aisner et al, 1986;Feld et al, 1987;Smith et al, 1987;Jackson et al, 1988;Spiro et al, 1989), and chemotherapy prolongs survival in patients with both limited and extensive disease. Unfortunately these high response rates do not result in significant numbers of cures, and the overall 2-year survival is 5.9%, with 3% alive at 7 years (Souhami & Law, 1990).…”

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confidence: 99%

“…Chemotherapy relieves symptoms and increases median survival even in patients who cannot be cured, but these benefits have to be weighed against the toxicity and inconvenience of treatment. In the course of a study designed to assess the optimum duration of chemotherapy (Spiro et al, 1989), a quality of life analysis suggested that symptoms improved if chemotherapy was stopped early (Geddes et al, 1990). …”

mentioning

confidence: 99%

A randomised trial of planned versus as required chemotherapy in small cell lung cancer: A Cancer Research Campaign trial

1992

Lung Cancer

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Summary In a study of chemotherapy as palliative treatment, 300 patients with untreated limited and extensive stage small cell lung cancer (SCLC), who did not have progressive disease after the first cycle of chemotherapy, were randomised to receive either regular 'planned' chemotherapy or chemotherapy given 'as required' (AR). All patients received the same chemotherapy: cyclophosphamide 1 gm m-2 i.v., vincristine 2 mg i.v., and etoposide 120 mg m-2 i.v. on day 1, and etoposide 100 mg b.d. orally on days 2 and 3. Planned chemotherapy was given regularly every 3 weeks. AR chemotherapy was given for tumour-related symptoms, or for radiological progression of disease. Both groups of patients were assessed every 3 weeks and a maximum of eight cycles of chemotherapy was given. A detailed quality of life assessment was made using daily diary cards.The median survival (MS) of patients given AR chemotherapy was not significantly worse than those receiving planned treatment [MS: Planned = 36 weeks (95% C.I. 32-40 weeks), AR = 32 weeks (95% C.I. 28-37 weeks) P = 0.960]. In the AR patients the median interval between treatments was 42 days. On average AR patients received half as much chemotherapy as planned patients. AR patients with a treatment-free interval (TFI) of more than 8 weeks between the first and second cycles of chemotherapy survived longer than those in whom this interval was less than 4 weeks; [MS: TFI >8 =47 weeks (95% C.I. 32-53 weeks); TFI <4 = 24 weeks (95% C.I. 17-34 weeks) P = 0.013]. Contrary to expectation, in the quality of life assessment the AR patients scored themselves as having more severe symptoms than patients receiving planned treatment.AR chemotherapy is a novel method of attempting to use cytotoxic drugs palliatively, which resulted in less drug treatment for approximately equivalent survival. However the palliative effect seen with as required treatment was less satisfactory than with planned chemotherapy.

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Duration of chemotherapy in small cell lung cancer: a Cancer Research Campaign trial

Cited by 160 publications

References 8 publications

A national survey of the chemotherapy regimens used to treat small cell lung cancer (SCLC) in the United Kingdom

A national survey of the chemotherapy regimens used to treat small cell lung cancer (SCLC) in the United Kingdom

Performance status and sensitivity to first‐line chemotherapy are significant prognostic factors in patients with recurrent small cell lung cancer receiving second‐line chemotherapy

A randomised trial of planned versus as required chemotherapy in small cell lung cancer: A Cancer Research Campaign trial

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