title: Conversion of Platinum-Etoposide-Resistant to Sensitive SCLC after Treatment with the Epi-Immunotherapeutic RRx-001: A Case Report.
abstract: BACKGROUND
  The response to first-line platinum doublets (cisplatin/etoposide) in small-cell lung cancer (SCLC) predicts the probability of subsequent response to second-line therapy. In general, the longer-lived the responses in first line, the better the outcome in second line, with the opposite prognosis for shorter-lived responses. Resistant SCLC is defined as relapse within 90 days of platinum-doublet treatment, and predictably correlates with shortened survival compared with sensitive disease, defined as relapse after 90 days.
  
  
  METHODS
  We present a patient with platinum-resistant SCLC that was rechallenged with cisplatin/etoposide in the context of the clinical trial TRIPLE THREAT (NCT02489903) after treatment with, and progression on, the resistance-reversing anticancer agent RRx-001.
  
  
  CONCLUSIONS
  The prolonged partial response of this platinum-resistant SCLC to reintroduced carboplatin/etoposide after RRx-001 belies and contradicts the prevailing orthodoxy in oncology that rechallenge with chemotherapy after the emergence of resistance is an exercise in futility and risk, which potentially exposes patients to toxicity without benefit.
authors.affiliation: Walter Reed Military Medical Center, Bethesda, MD, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Brzezniak
authors.forename: Bryan
authors.initials: B
authors.lastname: Oronsky
authors.forename: Jan
authors.initials: J
authors.lastname: Scicinski
authors.forename: Scott
authors.initials: S
authors.lastname: Caroen
authors.forename: Pedro
authors.initials: P
authors.lastname: Cabrales
authors.forename: Nacer
authors.initials: N
authors.lastname: Dean Abrouk
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kim
authors.forename: James F
authors.initials: JF
authors.lastname: Brown
authors.forename: Tony R
authors.initials: TR
authors.lastname: Reid
authors.forename: Christopher
authors.initials: C
authors.lastname: Larson
authors.forename: Arnold
authors.initials: A
authors.lastname: Oronsky
authors.forename: Regina
authors.initials: R
authors.lastname: Day
authors.forename: Aiste
authors.initials: A
authors.lastname: Degesys
authors.forename: Corey A
authors.initials: CA
authors.lastname: Carter
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001384:Azetidines / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D005047:Etoposide / Q000008:administration & dosage*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009574:Nitro Compounds / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D001384:Azetidines; D009574:Nitro Compounds; C577469:RRx-001; D005047:Etoposide; D002945:Cisplatin