An Advance in Small-Cell Lung Cancer Treatment—More or Less

摘要: Although small-cell lung cancer (SCLC) once constituted 20%–25% of all newly diagnosed cancers in North America, recent years the incidence has decreased to less than 15% (1,2). Nonetheless, deaths resulting from SCLC remain substantial and represent a major public health concern both United States abroad. Fortunately, is moderately chemo-sensitive neoplasm and, over past three decades, considerable progress been made management this disease (3,4). In fact, even though cure remains elusive for most patients, median survival now approaches 2 patients with limited-stage averages 9–10 months extensive-stage (5). commonly treated two-drug chemotherapy regimen consisting cisplatin (or carboplatin) etoposide (PE). Patients also receive thoracic radiotherapy, usually administered concurrently first or second cycle (6). Europe, situation somewhat different. Induction regimens tend be more varied, higher percentage oncologists using anthracycline-based drug combinations (7). However, practice pattern may change light recently reported randomized trial demonstrating superiority platinum-based therapy compared standard (8). these improvements treatment are gratifying, there clearly work do. Over last decade, several new drugs have identified excellent activity against firstand second-line settings, including irinotecan, topotecan, paclitaxel (9–12). Given biology SCLC, its proclivity toward early relapse subsequent refractoriness therapy, desire incorporate newer agents into front-line obvious. issue Journal, Reck et al. (13) report results phase III comparison carboplatin, etoposide, vincristine (CEV)—the arm—versus (TEC)—the experimental arm. Their attempt improve upon an existing followed time-honored traditional strategy adding substituting) active regimen. choice as substitute logical on basis novel mechanism action extant II data (9,12). study included limitedand disease. Notably, were sequential radiotherapy completion induction chemotherapy, which some experts believe not optimal method delivering (6,14). who progressed failed respond after initial two cycles switched cyclophosphamide, doxorubicin, vincristine. A total 614 enrolled 2-year period. Median TEC arm was superior that achieved by CEV (12.7 versus 11.7 months), hazard ratio death statistically significantly (hazard 1.22, 95% confidence interval 1.03 1.45; P .024). When analyzed stage, apparent advantage seemingly confined (17.6 16.6 months) those (9.8 10.0 reminiscent European less-than-optimal used Myelosuppression principal toxicity groups (13). Grade 3 4 neurotoxicity thrombocytopenia, however, common The authors concluded preferable SCLC. What can we make data? Should supplant PE SCLC? U.S. Intergroup cisplatin, (TEP) alone (15). nearly 600 whom had failure-free favored TEP arm, similar (13), different between arms (10.35 9.86 months; .27) contrast German There treatment-related TEP-treated group Greek Lung Cancer Cooperative Group conducted prospective (16). only 133 extensivestage closed before meeting intended accrual goal because excessive mortality no differences objective response rates times eight died whereas none EP (P .001). Moreover, associated grade neutropenia, 3–4 febrile diarrhea, asthenia, neurotoxicity. Similar high levels various I/II trials three-drug (17,18). do such toxicities their trial, possibly carboplatin substituted cisplatin.