title: Salvage treatment with topotecan in patients with irinotecan-refractory small cell lung cancer.
abstract: OBJECTIVE
  Although the efficacy of topotecan as a second-line chemotherapy for small-cell lung cancer (SCLC) has been consistently demonstrated in phase II/III clinical trials, the choice of irinotecan as the first-line therapy prevented the use of evidence-based option. This pilot study was conducted to determine the activity and safety of topotecan in SCLC patients refractory to first-line therapy with irinotecan and platinum.
  
  
  METHODS
  Patients with primary refractory (no response, or progression during or < or =90 days after last chemotherapy) SCLC after treatment with a combination of irinotecan and platinum, received topotecan 1.5 mg/m(2) per day as a 30-min infusion daily for 5 days, every 3 weeks.
  
  
  RESULTS
  Of 17 eligible patients, ten patients were previously treated with irinotecan plus cisplatin and 7 were treated with irinotecan plus carboplatin. The median age was 68 years (range 44-75) and the median interval from the last chemotherapy was 50 days (range 21-89). A total of 33 chemotherapy cycles were delivered (median 2; range 1-5). All 17 patients discontinued therapy due to disease progression and 5 patients had progressive disease before second cycle. Toxic effects were mainly hematologic (grade > or =3 neutropenia in 65% of patients) and fatigue (grade 3 in 47%). In an intent-to-treat analysis, two (12%) patients had a confirmed partial response and two patients achieved stable disease. Median progression-free and overall survivals were 1.7 months (95% CI, 1.5-1.9) and 3.4 months (95% CI, 1.7-5.0), respectively.
  
  
  CONCLUSIONS
  Topotecan monotherapy for patients with irinotecan-refractory SCLC does not appear highly active but the observation of some responses merits further study in patients with chemosensitive disease.
authors.affiliation: Department of Internal Medicine, Sungkyunkwan University Samsung Medical Center, Seoul, South Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Park
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.forename: Yujin
authors.initials: Y
authors.lastname: Kim
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Kyung
authors.forename: Chang Hyeok
authors.initials: CH
authors.lastname: An
authors.forename: Sang Pyo
authors.initials: SP
authors.lastname: Lee
authors.forename: Jeong Woong
authors.initials: JW
authors.lastname: Park
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Jeong
authors.forename: Jae-Ik
authors.initials: JI
authors.lastname: Lee
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Choi
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.forename: Dong Bok
authors.initials: DB
authors.lastname: Shin
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D016190:Carboplatin / Q000008:administration & dosage; D018288:Carcinoma, Small Cell / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016879:Salvage Therapy; D016019:Survival Analysis; D019772:Topotecan / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D000077146:Irinotecan; D019772:Topotecan; D016190:Carboplatin; D002945:Cisplatin; D002166:Camptothecin