Giovenzio Genestreti1, Marcello Tiseo2, Hirotsugu Kenmotsu3, Wakuda Kazushige3, Monica Di Battista4, Giovanna Cavallo4, Federica Carloni5, Alberto Bongiovanni6, Marco Angelo Burgio6, Claudia Casanova7, Giulio Metro8, Emanuela Scarpi9, Taner Korkmaz10, Seber Selcuk11, Kurup Roopa12, Raffaele Califano12. 1. Department of Medical Oncology, AUSL Bologna, Italy. Electronic address: g.genestreti@ausl.bologna.it. 2. Department of Medical Oncology, University Hospital of Parma, Italy. 3. Division of Thoracic Oncology, Shizouka Cancer Center, Shizouka, Japan. 4. Department of Medical Oncology, AUSL Bologna, Italy. 5. Department of Medical Oncology, AUSL Rimini, "Cervesi" Hospital, Cattolica, Italy. 6. Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy. 7. Department of Medical Oncology, "Santa Maria delle Croci" Hospital, Ravenna, Italy. 8. Department of Medical Oncology, "S. Maria della Misericordia" Hospital, Perugia, Italy. 9. Unit of Biostatistics and Clinical Trials, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy. 10. Dr Luffi Kirdar Research and Training Hospital, Istanbul, Turkey. 11. Marmara University Hospital, Department of Medical Oncology, Istambul, Turkey. 12. Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Abstract
UNLABELLED: Small-cell lung cancer has a high chemotherapeutic sensitivity but with disappointing outcome results. Patients with “sensitive disease” are those who respond to treatment with a long relapse-free interval (RFI): in these cases rechallenge with first-line chemotherapy might represent a therapeutic opportunity. Our largest retrospective experience confirmed that rechallenge is feasible with interesting outcome results; there are no statistical differences between RFI and outcome. INTRODUCTION: Patients with small-cell lung cancer (SCLC) that progresses after first-line (FL) chemotherapy have a poor prognosis and second-line (SL) chemotherapy has limited efficacy. Patients whose disease relapses/progresses > 90 days after FL platinum-based treatment are considered platinum-sensitive and could be rechallenged with a similar regimen. We conducted a multicenter retrospective analysis to evaluate outcomes of SCLC patients rechallenged with platinum/etoposide. PATIENTS AND METHODS: Records of all SCLC patients treated in 7 institutions between January 2007 and December 2011 were reviewed. The primary end point was overall survival from the time of rechallenge (OS-R); secondary end points were progression-free survival (PFS) and overall survival from the time of diagnosis (OS-D). Survival curves were calculated using the Kaplan-Meier method. RESULTS: Of the 2000 SCLC patients identified, 112 (5.6%) had sensitive disease treated with rechallenge platinum/etoposide; 65% were men with a median age of 64 years. At the time of diagnosis, 44% of patients had limited disease, 82% had an Eastern Cooperative Oncology Group performance status of 0 to 1. A median of 4 cycles of rechallenge was administered. Tumor response was 3% for complete response and 42% for partial response, 19% of patients maintained stable disease, 27% progressive disease, and 9% were not evaluable. Median PFS from the time of rechallenge was 5.5 months (95% confidence interval [CI], 4.4-6.3). Median OS-R and OS-D were 7.9 months (95% CI, 6.9-9.7) and 21.4 months (95% CI, 19.8-24.1), respectively. Subgroup analysis according to relapse-free interval (90-119 vs. 120-149 vs. > 150 days) did not show any statistically significant difference in PFS or OS-R. CONCLUSION: The outcome for SL chemotherapy for SCLC is poor. Rechallenge platinum/etoposide is a reasonable option with potentially better outcomes than standard chemotherapy.
UNLABELLED: Small-cell lung cancer has a high chemotherapeutic sensitivity but with disappointing outcome results. Patients with “sensitive disease” are those who respond to treatment with a long relapse-free interval (RFI): in these cases rechallenge with first-line chemotherapy might represent a therapeutic opportunity. Our largest retrospective experience confirmed that rechallenge is feasible with interesting outcome results; there are no statistical differences between RFI and outcome. INTRODUCTION:Patients with small-cell lung cancer (SCLC) that progresses after first-line (FL) chemotherapy have a poor prognosis and second-line (SL) chemotherapy has limited efficacy. Patients whose disease relapses/progresses > 90 days after FL platinum-based treatment are considered platinum-sensitive and could be rechallenged with a similar regimen. We conducted a multicenter retrospective analysis to evaluate outcomes of SCLCpatients rechallenged with platinum/etoposide. PATIENTS AND METHODS: Records of all SCLCpatients treated in 7 institutions between January 2007 and December 2011 were reviewed. The primary end point was overall survival from the time of rechallenge (OS-R); secondary end points were progression-free survival (PFS) and overall survival from the time of diagnosis (OS-D). Survival curves were calculated using the Kaplan-Meier method. RESULTS: Of the 2000 SCLCpatients identified, 112 (5.6%) had sensitive disease treated with rechallenge platinum/etoposide; 65% were men with a median age of 64 years. At the time of diagnosis, 44% of patients had limited disease, 82% had an Eastern Cooperative Oncology Group performance status of 0 to 1. A median of 4 cycles of rechallenge was administered. Tumor response was 3% for complete response and 42% for partial response, 19% of patients maintained stable disease, 27% progressive disease, and 9% were not evaluable. Median PFS from the time of rechallenge was 5.5 months (95% confidence interval [CI], 4.4-6.3). Median OS-R and OS-D were 7.9 months (95% CI, 6.9-9.7) and 21.4 months (95% CI, 19.8-24.1), respectively. Subgroup analysis according to relapse-free interval (90-119 vs. 120-149 vs. > 150 days) did not show any statistically significant difference in PFS or OS-R. CONCLUSION: The outcome for SL chemotherapy for SCLC is poor. Rechallenge platinum/etoposide is a reasonable option with potentially better outcomes than standard chemotherapy.
Authors: Damian von Eiff; Farastuk Bozorgmehr; Inn Chung; Denise Bernhardt; Stefan Rieken; Stephan Liersch; Thomas Muley; Sonja Kobinger; Michael Thomas; Petros Christopoulos; Martin Steins Journal: J Thorac Dis Date: 2020-03 Impact factor: 2.895
Authors: E Calvo; V Moreno; M Flynn; E Holgado; M E Olmedo; M P Lopez Criado; C Kahatt; J A Lopez-Vilariño; M Siguero; C Fernandez-Teruel; M Cullell-Young; A Soto Matos-Pita; M Forster Journal: Ann Oncol Date: 2017-10-01 Impact factor: 32.976