NEW YORK (Reuters Health) Aug 30 - The combination of epirubicin and ifosfamide is effective against relapsed or refractory small-cell lung cancer (SCLC), French researchers reported online August 9th in Lung Cancer.
Both drugs have clinical activity against SCLC, and the combination has been tolerated by patients with non-small cell lung cancer.
"This study validates in our opinion the use of this specific combination as it has a manageable toxicity and a good response profile," Dr. Jean-Louis Pujol from Montpellier Academic Hospital told Reuters Health in an email. "In addition, our results could be regarded as an additional clue in favor of anthracycline therapy in SCLC."
Dr. Pujol and colleagues tested the epirubicin/ ifosfamide combination in 70 patients (median age, 56 years) with SCLC after failure of a first-line regimen.
Fifteen patients (21.4%) had an objective response (including one complete response), and seven patients (10%) had stable disease.
Median overall survival was 3.9 months (which was lower than the 25 weeks reported in a recent study of topotecan monotherapy).
Most patients (71%) developed neutropenia. Thrombocytopenia and anemia were also common. There were three toxic deaths, two from neutropenic infection and one from cardiac failure.
High serum neuron-specific enolase (NSE) and brain metastases were the only independent negative prognostic variables.
"In our opinion, this combination could be proposed to patients with a good performance status, a good cardiac function, and who have had relapsed less than three months after end of first line chemotherapy (usually, Cis-etoposide or carbo-etoposide)," Dr. Pujol said. "This combination is also a good third line after failure of topotecan, a hydrosoluble analog of camptothecin that is active (and approved) in SCLC relapse."
"The first line of treatment in this setting depends upon the delay between the end of first line and time of recurrence," Dr. Pujol added. "When this duration is six months or more, the best is to reinduce the same chemo that had resulted in response induction as first line. Otherwise, our feeling is that in some cases, epirubicin-ifosfamide is the best choice (due to activity of anthracycline in SCLC)."
Both drugs have clinical activity against SCLC, and the combination has been tolerated by patients with non-small cell lung cancer.
"This study validates in our opinion the use of this specific combination as it has a manageable toxicity and a good response profile," Dr. Jean-Louis Pujol from Montpellier Academic Hospital told Reuters Health in an email. "In addition, our results could be regarded as an additional clue in favor of anthracycline therapy in SCLC."
Dr. Pujol and colleagues tested the epirubicin/ ifosfamide combination in 70 patients (median age, 56 years) with SCLC after failure of a first-line regimen.
Fifteen patients (21.4%) had an objective response (including one complete response), and seven patients (10%) had stable disease.
Median overall survival was 3.9 months (which was lower than the 25 weeks reported in a recent study of topotecan monotherapy).
Most patients (71%) developed neutropenia. Thrombocytopenia and anemia were also common. There were three toxic deaths, two from neutropenic infection and one from cardiac failure.
High serum neuron-specific enolase (NSE) and brain metastases were the only independent negative prognostic variables.
"In our opinion, this combination could be proposed to patients with a good performance status, a good cardiac function, and who have had relapsed less than three months after end of first line chemotherapy (usually, Cis-etoposide or carbo-etoposide)," Dr. Pujol said. "This combination is also a good third line after failure of topotecan, a hydrosoluble analog of camptothecin that is active (and approved) in SCLC relapse."
"The first line of treatment in this setting depends upon the delay between the end of first line and time of recurrence," Dr. Pujol added. "When this duration is six months or more, the best is to reinduce the same chemo that had resulted in response induction as first line. Otherwise, our feeling is that in some cases, epirubicin-ifosfamide is the best choice (due to activity of anthracycline in SCLC)."
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