SECOND LINE CHEMOTHERAPY FOR SCLC

NEW YORK (Reuters Health) Oct 27 - Second-line chemotherapy, especially platinum-based chemotherapy, may prolong survival in patients with small-cell lung cancer (SCLC), according to a multicenter retrospective study published online October 15th in Lung Cancer.

"There is not enough evidence to recommend a second-line treatment over another, but when a platinum-based regimen is feasible and the patient had a prolonged response after first-line, this could be the best option," the investigators say.

Their advice is based on an audit of 161 SCLC patients who failed first-line platinum-etoposide chemotherapy and received second-line chemotherapy in 15 institutions across Europe between May 1999 and July 2008.

Overall, re-treatment with platinum-based chemotherapy was associated with a 54% reduction of mortality compared with other regimens.

Until now, said lead author Dr. Marina Chiara Garassino from Ospedale Fatebenefratelli e Oftalmico, Milano, Italy and colleagues, second-line therapy has been linked with tumor regression but there's been only limited evidence of a clinical benefit.

Second-line chemotherapy regimens in the study included platinum-based rechallenge (18.6%), anthracycline-based chemotherapy (44.8%), topotecan (21.7%), and a variety of others (14.9%).

Most patients (70%) had responded to first-line platinum-based chemotherapy. After second-line chemotherapy, 1.2% achieved complete remission, 21.7% had partial remission, 20.5% had stable disease, and 56.6% had progressive disease.

Response rates were higher in patients who responded to first-line therapy, and rates were numerically (but not statistically) higher in patients who were rechallenged with a platinum-based therapy (34.5%) than in those who did not receive platinum-based therapy (17.5%; p=0.06).

For all patients treated with second-line chemotherapy, median progression-free survival was 4.3 months, and median overall survival was 5.8 months.

Progression-free survival and overall survival were significantly higher among patients who received platinum-based rechallenge than among patients who received other regimens.

In multivariate analysis, there was a non-significant trend for superior progression-free and overall survival with the platinum-based regimen among patients who relapsed at least 3 months after completion of first-line treatment.

Additional analysis identified a time-to-progression of 12 months after completion of first-line chemotherapy as the best cut-off to achieve the highest benefit from platinum-based rechallenge.

The researchers believe their results "are provocative for further evaluation of platinum rechallenge compared to topotecan in SCLC patients independently of their platinum sensitivity."

Lung Cancer. Posted online October 15, 2010. Abstract