Practice guideline for the role of combination chemotherapy in the initial management of limited-stage small-cell lung cancer

Laurie, Scott A.; Logan, Diane; Markman, B.; Mackay, Jean A.; Evans, William K.

doi:10.1016/j.lungcan.2003.09.002

Cited by 35 publications

(17 citation statements)

References 52 publications

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“…The overall response rate was 92%, which is comparable to other studies (Murray et al, 1993;Laurie et al, 2004). The 2-and 5-year survival rates of 46 and 27% are promising, especially when compared to the survival data of doxorubicine containing regimens with sequential radiotherapy (Bunn et al, 1986;Giaccone et al, 1993).…”

Section: Discussionsupporting

confidence: 77%

“…The 2-and 5-year survival rates of 46 and 27% are promising, especially when compared to the survival data of doxorubicine containing regimens with sequential radiotherapy (Bunn et al, 1986;Giaccone et al, 1993). Other platinum-containing regimens are considered more effective, even when combined with sequential radiotherapy as shown in an overview by Laurie et al (2004). This all adds to the evidence that concurrent chemoradiation therapy should be considered standard treatment for patients with LS disease and good performance.…”

Section: Discussionmentioning

confidence: 94%

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Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer: a Dutch multicenter phase II study

Baas

Belderbos

Senan³

et al. 2006

Br J Cancer

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To improve the prognosis of limited stage small cell lung cancer (LS-SCLC) the addition of concurrent thoracic radiotherapy to a platinum-containing regimen is important. In the Netherlands, we initiated a multicenter, phase II study, of the combination of four cycles of carboplatin (AUC 5), paclitaxel (200 mg m À2) and etoposide (2 Â 50 mg orally for 5 days) combined with 45 Gy (daily fractions of 1.8 Gy). The radiation was given to the involved field and concurrently with the second and third chemotherapy cycle. Patients with a partial or complete response received prophylactic cranial irradiation to a dose of 30 Gy. From January 1999 to December 2001, 37 of the 38 patients with LS-SCLC entered were eligible for toxicity analysis and response. Grade 3 and 4 haematological toxicity occurred in 57% (21/37) with febrile neutropenia in 24% (9/37). There were no treatment-related deaths or other grade 4 toxicity. Grade 3 toxicities were oesophagitis (27%), radiation pneumonitis (6%), anorexia (14%), nausea (16%), dyspnea (19%) and lethargy (22%). The objective response rate was 92% (95% confidence interval (CI) 80 -98%) with a median survival time of 19.5 months (95% CI 12.8 -29.2). The 1-, 2-and 5-year survival rate was 70, 47 and 27%, respectively. In field local recurrences occurred in six patients. Distant metastases were observed in 19 patients of which 13 in the brain. This study indicates that combination chemotherapy with concurrent involved-field radiation therapy is an effective treatment for LS-SCLC. Despite PCI, the brain remained the most important site of recurrence.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 94%

Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer: a Dutch multicenter phase II study

Baas

Belderbos

Senan³

et al. 2006

Br J Cancer

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“…Furthermore, consideration could be given to dividing the cisplatin infusion into two administrations on days 1 and 2 in order to increase tolerability [14]. In small-cell lung cancer an alternative cisplatin/etoposide schedule with the cisplatin dose divided over more than 1 day was developed in the 1980s at the National Cancer Institute of Canada, and has become standard practice in many Canadian and European institutions owing to its better tolerability and to the need for reduced outpatient hydration [15, 16]. …”

Section: Introductionmentioning

confidence: 99%

Short Schedule of Cisplatin and Vinorelbine: A Dose-Finding Study in Non-Small-Cell Lung Cancer

Zucali

Parra²,

Cavina

et al. 2006

Oncology

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Objectives: A dose-finding study of a new cisplatin/vinorelbine schedule was done to increase activity of the combination, and improve compliance of non-small-cell lung cancer patients. Methods: Beginning with cisplatin 40 mg/m² on days 1, 2 and vinorelbine 20 mg/m² on days 1, 3, increasing dose levels up to the maximum tolerated dose (MTD) were tested in a series of 6-patient cohorts. If 3 of 6 patients experienced dose-limiting toxicity in the first 3 cycles, the previous dose was considered the recommended dose (RD). Once the MTD was reached, granulocyte-colony-stimulating factor was prophylactically added to the treatment of a new patient cohort to improve the therapeutic ratio. Results: We enrolled 35 stage IIIA/B or IV patients between August 2001 and February 2002. The RD was cisplatin 45 mg/m² and vinorelbine 25 mg/m², with relative dose intensities (RDIs) of 95 and 97%, respectively, and an actual received dose intensity (ARDI) of 28.62 and 16.07 mg/m²/week, respectively. Overall grade 3–4 toxicities were: neutropenia (71%), febrile neutropenia (25%), anemia (8%), and constipation (17%). The overall response rate was 64.3% (CI: 44.1–81.4%). Conclusions: ARDI and RDI of our modified cisplatin/vinorelbine regimen were not inferior to those of conventional weekly schedules; its acceptable toxicity profile and manageability may justify its use in clinical practice.

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“…Several evidence-based guidelines for limited disease SCLC described uncertainty in terms of the optimal regimen, schedule of drug administration, duration of chemotherapy, and maintenance chemotherapy. 23,24 Although there is a guideline that recommends a maximum of six cycles of chemotherapy, 23 the trend in clinical trials and practice, including the current study, has been to use only four cycles of cisplatin-based chemotherapy. In patients with CR with elevated Pro GRP after four cycles of chemotherapy, two additional cycles of chemotherapy might be possible to eliminate tumor cells, to normalize Pro GRP levels, and to reduce the risk of brain recurrence.…”

Section: Discussionmentioning

confidence: 97%

Pro‐gastrin–releasing peptide as a factor predicting the incidence of brain metastasis in patients with small cell lung carcinoma with limited disease receiving prophylactic cranial irradiation

Yonemori

Sumi

Fujimoto

et al. 2005

Cancer

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BACKGROUNDProphylactic cranial irradiation (PCI) reduces the incidence of brain metastasis with an effect on overall survival in patients with small cell lung carcinoma (SCLC). In spite of multidisciplinary intensive treatment approaches, many patients still experience brain metastasis. The authors retrospectively analyzed the characteristics of the first failure event due to brain metastasis (FBM) in patients treated with PCI.METHODSBetween January 1990 and April 2004, 71 patients with limited disease SCLC were treated with PCI after completing systemic treatment at the National Cancer Center Hospital (Tokyo, Japan). Univariate and multivariate analyses were used to identify factors related to FBM and survival.RESULTSThe FBM and overall incidence of brain metastasis (OBM) were 16.9 % (12 of 71) and 26.8% (19 of 71), respectively. Median time to progressive disease and median survival were 8.4 months and 21.6 months, respectively. Elevation of pro‐gastrin–releasing peptide (Pro GRP) level before PCI was found to be a significant predictive and prognostic factor for FBM, OBM, and survival on multivariate analysis (P = 0.007, P = 0.025, and P = 0.009, respectively).CONCLUSIONSAn elevated Pro GRP level before PCI was found to be significantly related to FBM and survival, and should be considered before PCI is performed. Cancer 2005. © 2005 American Cancer Society.

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Practice guideline for the role of combination chemotherapy in the initial management of limited-stage small-cell lung cancer

Cited by 35 publications

References 52 publications

Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer: a Dutch multicenter phase II study

Concurrent chemotherapy (carboplatin, paclitaxel, etoposide) and involved-field radiotherapy in limited stage small cell lung cancer: a Dutch multicenter phase II study

Short Schedule of Cisplatin and Vinorelbine: A Dose-Finding Study in Non-Small-Cell Lung Cancer

Pro‐gastrin–releasing peptide as a factor predicting the incidence of brain metastasis in patients with small cell lung carcinoma with limited disease receiving prophylactic cranial irradiation

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