New state of the art in small-cell lung cancer.
Chemotherapy is currently the main treatment for all stages of small-cell lung cancer. In extensive disease, etoposide/cisplatin (Platinol) is standard treatment, and in limited disease, etoposide/cisplatin with early concurrent thoracic radiotherapy twice daily is a typical regimen. Therapeutic outcomes, however, leave substantial room for improvement. The topoisomerase I inhibitor irinotecan (Camptosar, CPT-11) is one of the most active agents against small-cell lung cancer. In a phase II study, irinotecan yielded response rates of 33% to 50%, depending on prior treatment status. Combinations with cisplatin have resulted in a median survival of 14.3 months in patients with limited disease and 13.0 months in extensive disease. A phase III study in extensive-disease small-cell lung cancer compared irinotecan/cisplatin and standard etoposide/cisplatin regimens, and demonstrated a significant difference in survival in the irinotecan-containing arm (411 vs 282 days). Planned phase III studies in North America will confirm and extend these results. Based on these promising data, irinotecan/cisplatin regimens represent a new standard treatment for extensive-disease small-cell lung cancer.
Tamura
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National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. ttamura@ncc.go.jp
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality; D002945:Cisplatin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate
D005047:Etoposide; D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin