Small Cell Lung Cancer in Elderly Patients: A Review

Owonikoko, Taofeek K.; Ramalingam, Suresh S.

doi:10.6004/jnccn.2008.0028

Cited by 13 publications

(7 citation statements)

References 64 publications

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“…Older smokers and former smokers (especially young females) are the highest risk group for developing SCLC. However, approximately 40% of cases are diagnosed in patients older than 70 years of age and this proportion continues to rise in contrast to the continued decline in the incidence of SCLC among the general population [15]. Additionally, the proportion of women with SCLC increased from 28% in 1973 to 50% in 2002 [16] and it has been shown that female gender in limited-stage (LS)-SCLC may be a good prognostic factor of both OS and toxicity.…”

Section: Small-cell Lung Cancer In the Elderlymentioning

confidence: 97%

Radiochemotherapy in the elderly with lung cancer

Casas¹,

Kępka²,

Agarwal³

et al. 2009

Expert Review of Anticancer Therapy

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Lung cancer is the leading cause of cancer mortality with the median age of incidence being 69 years in males and 67 years in females. Radiochemotherapy (RT-CHT) is indicated in locally advanced non-small-cell lung cancer and limited-stage small-cell lung cancer; however, a significant under-representation of the elderly has been observed in patient recruitment in cancer treatment trials. In the last decades of the 20th Century, studies showed that elderly patients achieved the best quality-adjusted survival with radiotherapy alone, but recent trials have found that fit elderly patients benefit from concurrent RT-CHT, although with more short-term toxicity. Age alone should not exclude fit patients and deprive them of the standard treatment. Using tools, such as comprehensive geriatric assessment, a patient's tolerance to therapy can be assessed and monitoring can be performed. This review will focus on RT-CHT treatment in elderly patients with nonoperable stage III non-small-cell lung cancer and limited-stage small-cell lung cancer exclusively.

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Section: Small-cell Lung Cancer In the Elderlymentioning

confidence: 97%

Radiochemotherapy in the elderly with lung cancer

Casas¹,

Kępka²,

Agarwal³

et al. 2009

Expert Review of Anticancer Therapy

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“…Platinum-based, frontline chemotherapy has been established as the standard treatment for SCLC patients [17][18][19][20][21], with marked responses in approximately 70% of patients with limited-stage SCLC [22][23][24][25] and in 50% of patients with extensive-stage SCLC [12,13,19,26]. Despite this high initial response to chemotherapy, the majority of SCLC patients experienced relapse and develop drug resistance.…”

Section: Discussionmentioning

confidence: 99%

A Phase II Study of Irinotecan for Patients with Previously Treated Small-Cell Lung Cancer

et al. 2018

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Objective: Chemotherapy with irinotecan plus cisplatin has shown promise in chemo-naïve small-cell lung cancer (SCLC) patients. However, irinotecan treatment for relapsed or refractory SCLC has not been adequately evaluated. This phase II study evaluated the appropriate treatment schedule of irinotecan as a single agent. This study was designed to determine the antitumor activity, toxicity, and survival in previously treated SCLC patients. Methods: Previously treated SCLC patients with at least one platinum-based regimen received irinotecan (100 mg/m²) on days 1 and 8, every 3 weeks, until disease progression. The assessment of the response rate was the primary endpoint. Results: Thirty patients were enrolled, with an objective response rate of 41.3% (95% confidence interval [CI] 25.5–59.3), and a disease control rate of 69%. Median progression-free and overall survival was 4.1 months (95% CI, 2.2–5.4) and 10.4 months (95% CI, 8.1–14), respectively. The grade 3/4 hematological toxicities were neutropenia (36.7%), thrombocytopenia (3.3%), anemia (13.3%), and febrile neutropenia (6.6%). There were no grade 4 nonhematological toxicities. Frequent grade 3 nonhematological toxicities included diarrhea (10%), anorexia (6.6%), and hyponatremia (6.6%). Conclusions: This phase II study showed a high objective response rate and long survival. Irinotecan monotherapy schedule used was well tolerated, and could be an active treatment option for these patients.

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“…1,2 Majority of these patients have extensive stage of the disease, which is incurable with currently available treatment options. The efficacy of platinum-based chemotherapy for frontline therapy has been established in randomized clinical trials 3–7 with objective responses in approximately 70% of patients with limited stage SCLC and in 50% of patients with extensive stage disease. 5,8–10 Despite this high initial response, majority of SCLC patients require salvage therapy for disease progression within several months following frontline therapy.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Analysis of Efficacy of Second-Line Chemotherapy in Sensitive and Refractory Small-Cell Lung Cancer

Owonikoko

Behera

Chen

et al. 2012

Journal of Thoracic Oncology

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127

101

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Introduction SCLC patients unresponsive or relapsing within 90 days following frontline chemotherapy have poor prognosis and are treated with regimens different than the first-line regimen. Potential differences in the efficacy of second line therapy for refractory and sensitive SCLC have not been well studied. Methods Studies that enrolled sensitive and refractory (relapse more than or less than 90 days) SCLC patients for second-line therapy were identified using electronic databases (MEDLINE, EMBASE, and Cochrane library) and meeting abstracts databases. A systematic analysis was conducted using Comprehensive Meta Analysis (Version 2.2.048) software to calculate the Odds ratio of response and 95% confidence limits. Median overall survival time for sensitive and resistant SCLC patients was compared by 2-sided Student’s T-Test. We tested for significant heterogeneity by Cochran’s chi-square test and I square index. Results Twenty one studies published between 1984 and 2011 were eligible for this analysis with a total of 1692 patients enrolled; 912 with sensitive and 780 with refractory SCLC. The overall RR was 17.9% with a higher RR of 27.7% (range: 0 – 77%) for sensitive SCLC versus 14.8% (range: 0 – 70%) for refractory patients; p=0.0001. Pooled overall Odds ratio of response was 2.235 (95% CI: 1.518 – 3.291; p=0.001) favoring patients with sensitive disease. Median overall survival time was 6.7 months with a weighted survival of 7.7 and 5.4 months for sensitive and refractory SCLC respectively (p=0.0035). Conclusions Refractory SCLC patients derive modest clinical benefit from second line chemotherapy. However, response and survival outcomes are superior with chemosensitive disease.

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Small Cell Lung Cancer in Elderly Patients: A Review

Cited by 13 publications

References 64 publications

Radiochemotherapy in the elderly with lung cancer

Radiochemotherapy in the elderly with lung cancer

A Phase II Study of Irinotecan for Patients with Previously Treated Small-Cell Lung Cancer

A Systematic Analysis of Efficacy of Second-Line Chemotherapy in Sensitive and Refractory Small-Cell Lung Cancer

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