Alternative 1st Treatment for Small-Cell Lung Cancer Patients with Extensive Disease

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Lung cancer is the most common diagnosed cancer worldwide and small-cell lung cancer (SCLC) accounts for only 10%-15% of lung cancer cases.  Etoposide in combination with cisplatin (EP) or carboplatin is currently considered the standard of care in most countries, but the survival rates are generally poor.  The median survival rates of this regimen are less than 12 months.

A new study published in the March issue of the Annals of Oncology reported that irinotecan in combination with cisplatin (IP) can be an alternative 1st treatment for patients with small-cell lung cancer with extensive disease. 

The study randomized 400 previously untreated small-cell lung cancer patients with extensive disease to either IP (irinotecan plus cisplatin) or EP (etoposide plus cisplatin).  The results indicated that there was no difference in median overall survival between the two regimens (10.2 vs. 9.7 months respectively), even thought patients on the IP regimen trended towards a better outcome.  The 1- and 2- year survival rates were 41.9% versus 38.9 and 16.3% versus 8.2% respectively. 

The two regimens differed in side-effects profile.  More patients in the IP arm that the EP arm experienced Grade ¾ vomiting (10.9% vs. 4.4%) and diarrhea (15.4% versus 0.5%).  Hematological toxicity, however, was more frequent in the EP arm than the IP arm (59.6% vs. 38.1%).

To conclude, IP can be considered an alternative treatment option for patients with small-cell lung cancer patients with extensive disease.

Zatloukal P et.al.  Annals of Oncology, March 15, 2010

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