title: Re-challenge chemotherapy with gemcitabine plus carboplatin in patients with non-small cell lung cancer.
abstract: Despite recent improvements to current therapies and the emergence of novel agents to manage advanced non-small cell lung cancer (NSCLC), the patients' overall survival remains poor. Re-challenging with first-line chemotherapy upon relapse is common in the management of small cell lung cancer but is not well reported for advanced NSCLC. NSCLC relapse has been attributed to acquired drug resistance, but the repopulation of sensitive clones may also play a role, in which case re-challenge may be appropriate. Here, we report the results of re-challenge with gemcitabine plus carboplatin in 22 patients from a single institution who had previously received gemcitabine plus platinum in the first-line setting and had either partial response or a progression-free interval of longer than 6 months. In this retrospective study, the charts of patients who underwent second-line chemotherapy for NSCLC in our cancer center between January 2005 and April 2010 were reviewed. All the patients who received a combination of gemcitabine and carboplatin for re-challenge were included in the study. These patients were offered second-line treatment on confirmation of clear radiological disease progression. The overall response rate was 15% and disease control rate was 75%. The median survival time was 10.4 months, with 46% of patients alive at 1 year. These results suggest that re-challenge chemotherapy should be considered in selected patients with radiological partial response or a progression-free survival of longer than 6 months to the initial therapy.
authors: Institute of Cancer Research/Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK. khurum.khan@icr.ac.uk.
authors: Khurum
authors: K
authors: Khan
authors: Gerard G
authors: GG
authors: Hanna
authors: Lynn
authors: L
authors: Campbell
authors: Paula
authors: P
authors: Scullin
authors: Adnan
authors: A
authors: Hussain
authors: Ruth L
authors: RL
authors: Eakin
authors: Jonathan
authors: J
authors: McAleese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine
references: Cancer Res. 2005 Feb 15;65(4):1479-88
references: 15735036
references: Lung Cancer. 2010 Jun;68(3):427-32
references: 19674811
references: Cancer Res. 2005 Oct 15;65(20):9510-6
references: 16230416
references: Mol Cancer Ther. 2005 May;4(5):855-63
references: 15897250
references: Eur J Cancer Clin Oncol. 1987 Nov;23(11):1697-9
references: 2828074
references: Lung Cancer. 2005 Jan;47(1):85-91
references: 15603858
references: Mol Cancer Ther. 2006 Jul;5(7):1800-6
references: 16891466
references: N Engl J Med. 2006 Sep 7;355(10):983-91
references: 16957145
references: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references: 20610543
references: Eur J Cancer. 2000 Oct;36(15):1974-83
references: 11000580
references: Bull Cancer. 2000 Dec;87(12):881-6
references: 11174117
references: Anticancer Res. 2007 Nov-Dec;27(6C):4457-60
references: 18214060
references: J Clin Oncol. 1991 Sep;9(9):1618-26
references: 1651993
references: J Clin Oncol. 2008 Oct 1;26(28):4617-25
references: 18678835
references: J Clin Oncol. 2004 May 1;22(9):1589-97
references: 15117980
references: Lung Cancer. 2010 Sep;69(3):315-8
references: 20071052
references: Oncology. 2010;79(1-2):150-8
references: 21150230
references: N Engl J Med. 2005 Jul 14;353(2):123-32
references: 16014882
references: Ann Oncol. 2006 Mar;17 Suppl 2:ii5-10
references: 16608983
references: Oncology (Williston Park). 2003 Mar;17(3):357-64
references: 12661267
references: PLoS One. 2008;3(11):e3695
references: 19002265
references: PLoS One. 2007 Nov 07;2(11):e1129
references: 17987116
references: Thorax. 2004 Oct;59(10):828-36
references: 15454647
references: BMC Res Notes. 2012 Sep 03;5:482
references: 22943698
references: J Clin Oncol. 2000 May;18(10):2095-103
references: 10811675
references: Ann Oncol. 2007 Mar;18(3):522-8
references: 17229776
references: Lancet. 2005 Oct 29-Nov 4;366(9496):1527-37
references: 16257339
references: Br J Cancer. 2008 May 20;98(10):1710-5
references: 18414411
references: Anticancer Res. 1997 Sep-Oct;17(5B):3777-80
references: 9427779