P109 Combined Chemotherapy Versus Topotecan Monotherapy as Second-Line Treatment for Patients with Sensitive Relapsed SCLC

Abstract

Background: Cisplatin, etoposide and irinotecan are primary drugs in the treatment of small cell lung cancer. We did this retrospective study to investigate whether combined chemotherapy with cisplatin, etoposide, and irinotecan was better than topotecan alone as second-line chemotherapy in patients with sensitive relapsed SCLC. Method: Between 1st Sep, 2014 and 30th Sep, 2017，We collected the patients information in Jilin Province Cancer Hospital. All patients with SCLC responded in first-line treatment and showed radiological evidence of disease relapse or progression at least 90 days after completion of the first-line treatment. 36 patients received combination chemotherapy with cisplatin plus etoposide plus irinotecan and 42 patients received topotecan alone. Combination chemotherapy consisted of five 2-week courses of intravenous cisplatin 25 mg/m 2 on days 1 and 8, intravenous etoposide 60 mg/m 2 on days 1e3, and intravenous irinotecan 90 mg/m 2 on day 8. Topotecan therapy consisted of four courses of intravenous topotecan 1.0 mg/m 2 on days 1e5, every 3 weeks. The primary endpoint was overall survival, which was analysed with a onesided a of 5%, and safety was assessed in all patients who received at least one dose of drugs. Results: The median follow-up for patients was 20.6 months (IQR 17.1e26.9). Overall survival was significantly longer in the combination chemotherapy group (median 16.3 months, 95% CI 13.8e19.1) than in the topotecan group (13.1 months, 10.2e15.4; hazard ratio 0.72, 90% CI 0.58e0.83; p¼0.0097). The most common grade 3/4 adverse events were neutropenia (31 [86.1%] patients in the combination chemotherapy group vs 28 [66.7%] patients in the topotecan group), anaemia (26 [72.2%] vs 10 [23.8%]), and leucopenia (29 [80.6%] vs 21 [50.0%]). Grade 3/4 febrile neutropenia was more common in the combination chemotherapy group than in the topotecan group (10 [27.8%] vs 4[9.5%]), as was grade 3/4 thrombocytopenia (13 [36.1%] vs 11 [26.2%]). One treatment-related death (febrile neutropenia with pulmonary infection) occurred in the combination chemotherapy group and none in the topotecan group. Conclusion: Combination chemotherapy with cisplatin plus etoposide plus irinotecan could be considered as a treatment option in secondline chemotherapy for selected patients with sensitive relapsed SCLC. But the combination chemotherapy group had higher incidence of adverse events than the topotecan group and we should explore appropriate drug dosages in Chinese people.

Real-world treatment patterns and outcomes in small-cell lung cancer: a systematic literature review

“…Seventeen studies (21,23,24,28,40,(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) reported on the treatment of SCLC patients beyond first-line treatment. Patients were either retreated with their first- (40).…”