title: Second-Line Therapy of Small-Cell Lung Cancer: Topotecan Compared to a Combination Treatment with Adriamycin, Cyclophosphamide And Vincristine (ACO) - a Single Center Experience.
abstract: BACKGROUND
  Randomized trials established topotecan and the combination of adriamycin, cyclophosphamide and vincristine (ACO) as second-line therapy options for small-cell lung cancer. We retrospectively evaluated the outcome of SCLC patients undergoing second-line chemotherapy.
  
  
  METHODS
  92 consecutive patients with a diagnosis of SCLC between 2000 and 2010 were analyzed.
  
  
  RESULTS
  86 patients (93.5%) were evaluable for outcome analysis. All patients diagnosed with limited disease (LD) SCLC received platinum-based chemotherapy as first-line treatment. 69 patients (98.6%) diagnosed with extensive disease (ED) SCLC received first-line palliative chemotherapy. In the total cohort, the median overall survival (OS) was 10.3 months (19.2 months and 9.2 months for LD-SCLC and ED-SCLC, respectively). 42 patients received second-line therapy (ACO in 47.6% and topotecan in 31.0% of patients, respectively). Eight patients (19.0%) were re-challenged with platinum/etoposide. Neither the overall response rate (52.9% vs. 22.2%; p=0.128) nor progression-free survival (2.4 vs. 2.4 months; p=0.794) or OS (5.5 vs. 5.0 months; p=0.997) were significantly different between ACO and topotecan. ACO-treated patients showed a trend towards a longer duration of inpatient care.
  
  
  CONCLUSIONS
  We showed similar outcomes as reported in clinical trials. Second-line combination chemotherapy with ACO did not show superiority to intravenous topotecan, but was associated with a clinically relevant longer hospitalization time.
authors.affiliation: 1. Department Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Hagmann
authors.affiliation: 1. Department Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Viviane
authors.initials: V
authors.lastname: Hess
authors.affiliation: 1. Department Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ; 2. Lung Tumor Center, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Alfred
authors.initials: A
authors.lastname: Zippelius
authors.affiliation: 1. Department Internal Medicine, Medical Oncology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland ; 2. Lung Tumor Center, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
authors.forename: Sacha I
authors.initials: SI
authors.lastname: Rothschild
keywords: ACO; Small cell lung cancer; chemotherapy; second-line therapy; topotecan