title: European organization for research and treatment of cancer (EORTC) 08957 phase II study of topotecan in combination with cisplatin as second-line treatment of refractory and sensitive small cell lung cancer.
abstract: OBJECTIVE
  The purpose of this study was to assess the activity and toxicity of a combined regimen of topotecan and cisplatin in "sensitive" (s) and "refractory" (r) small-cell lung cancer (SCLC) patients treated previously.
  
  
  METHODS
  Patients with measurable SCLC and progressive disease after one first-line regimen were eligible for the study. Patients were enrolled in two separate groups: r group (patients who failed first-line treatment <3 months from treatment discontinuation) and s group (patients who responded to first-line treatment and progressed >or=3 months after treatment discontinuation). Cisplatin was given i.v. at the dose of 60 mg/m(2) on day 1, and topotecan was administered as a daily i.v. infusion at the dose of 0.75 mg/m(2) from day 1 to 5, every 3 weeks.
  
  
  RESULTS
  A total of 110 eligible (68 s and 42 r) patients were enrolled from 24 institutions. The main patient characteristics were as follows: median age 60 (s) and 55 (r) years, median performance status 1 for both (s) and (r). Seventy-four percent (s) and 67% (r) had extensive stage disease, including 22% and 36%, respectively, with brain metastases. A total of 398 chemotherapy courses were administered [median 4 (s) and 3 (r) per patient]. The most frequent and serious toxicity was myelosuppression. Grade IV neutropenia occurred in 62% (s) and 49% (r) of patients, with a 19% (s) and 15% (r) incidence of febrile neutropenia, and grade IV thrombocytopenia in 54% (s) and 44% (r). Most of these toxicities occurred during the first chemotherapy course and led to topotecan dose reduction and/or delay in the following courses. Grade III-IV nonhematological toxicity was uncommon. Five deaths possibly related to toxicity occurred among s patients only. Objective responses have been documented in 20 s patients, 19 partial responses and 1 complete response, (29.4% response rate; 95% confidence interval, 19-42), whereas, among r patients, 10 partial responses have been observed (23.8% response rate; 95% confidence interval, 12-39). Median survival for s and r was 6.4 and 6.1 months, respectively.
  
  
  CONCLUSIONS
  The combination of cisplatin and topotecan, at this dose and schedule, shows activity and promising results in patients with refractory SCLC, with reversible myelosuppression being the main side effect. Additional development of this regimen, using better-tolerated schedules, is warranted in patients with refractory SCLC.
authors.affiliation: Istituto Nazionale per la Ricerca sul Cancro, 16132 Genoa, Italy. andrea.ardizzoni@istge.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.forename: Christian
authors.initials: C
authors.lastname: Manegold
authors.forename: Channa
authors.initials: C
authors.lastname: Debruyne
authors.forename: Rabab
authors.initials: R
authors.lastname: Gaafar
authors.forename: Erika
authors.initials: E
authors.lastname: Buchholz
authors.forename: Egbert F
authors.initials: EF
authors.lastname: Smit
authors.forename: Pilar
authors.initials: P
authors.lastname: Lianes
authors.forename: Guul
authors.initials: G
authors.lastname: ten Velde
authors.forename: Lionel
authors.initials: L
authors.lastname: Bosquee
authors.forename: Catherine
authors.initials: C
authors.lastname: Legrand
authors.forename: Carlo
authors.initials: C
authors.lastname: Neumaier
authors.forename: Kathrine
authors.initials: K
authors.lastname: King
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D019772:Topotecan / Q000008:administration & dosage*
chemical_list: D000970:Antineoplastic Agents; D019772:Topotecan; D002945:Cisplatin