S-1 Maintenance Therapy in Extensive Stage Small-Cell Lung Cancer—A Randomized Clinical Study

Abstract

Small-cell lung cancer (SCLC) is a recalcitrant cancer for its dismal prognosis although extensive research had been done. Four to 6 cycles platinum-based chemotherapy is the mainstay treatment for the extensive-stage disease; but the role of maintenance treatment is not fully understood. This is a phase 2, open-label study. Patients with extensive-stage SCLC reaching an objective response or stable disease (SD) after induction chemotherapy were randomly assigned (1:1) with a minimization procedure. One group received oral S-1 and the other group received placebo as maintenance treatment until disease progression or unacceptable toxicities. The primary end point of this study was progression-free survival (PFS), and the secondary end points were overall survival (OS), response rates, and toxicities. This study was based on earlier work, the preliminary results was reported on 2019 ASCO annual meeting. A total of 89 patients were enrolled, of whom 45 received S-1 maintenance therapy and 44 received placebo. The median PFS and OS were 6.35 months and 10.82 months in the S-1 group, as compared to 5.98 months and 10.09 months in the placebo group. The PFS was 7.2 months and 5.3 months, and OS was 12.9 months and 10.9 months in patients with an objective response compared to in patients with SD after induction chemotherapy, respectively. S-1 maintenance therapy did not prolong PFS or OS in patients with extensive-stage SCLC; tumor regression rate was the prognostic factor of PFS or OS. Further research with novel agents in the maintenance setting is warranted.

“Highly Exposed Chinese Herbal Medicine” Combined With Apatinib as Maintenance Treatment Following First-Line or Second-Line Chemotherapy for Extensive-Stage Small-Cell Lung Cancer: A Single-Arm, Prospective Study

“…The major reason is the drug resistance in the patients with disease progression after the first-line chemotherapy, which consequently leads to extremely poor responses to the second-line chemotherapy. 22 Integrative Chinese and Western medicine has been suggested as an alternative treatment (maintenance treatment) for ES-SCLC. To the best of our knowledge, this is the first study that investigated the efficacy and safety of “highly exposed Chinese herbal medicine” combined with apatinib as the maintenance treatment for patients with ES-SCLC.…”

Systemic Therapy for Small-Cell Lung Cancer: ASCO-Ontario Health (Cancer Care Ontario) Guideline

“…32,33,120,[132][133][134][135] The optimal duration of chemotherapy for ES-SCLC is not clearly defined; however, 4-6 cycles of chemotherapy should be given based on patient tolerance and response to therapy. Numerous chemotherapy-based strategies have been studied in randomized trials, including dose intensification, 65,66 three-drug cytotoxic regimens, 63,73,136,137 alkylatoranthracycline-based regimens, 68,69,75 platinum-based nonetoposide regimens, 71,72,74 alternating non-cross-resistant regimens, 69,75 maintenance therapy, 61,62,87 and consolidation therapy. 76 All have failed to yield convincing improvements in survival and/or resulted in unacceptable toxicity.…”

Synergistic Antitumor Effects of Anlotinib Combined with Oral 5-Fluorouracil/S-1 via Inhibiting Src/AKT Signaling Pathway in Small-Cell Lung Cancer

“…5-Fluorouracil (5-FU) is a fluorouracil-containing analogue that was designed as an anticancer drug more than 40 years ago and has been used to treat many cancers including SCLC [ 15 , 16 ]. 5-FU works mainly by inhibiting thymine synthase activity to prevent the formation of thymine which is needed for DNA synthesis and destroy the structure and function of RNA by abnormal nucleotide incorporation.…”