Topotecan Versus Observation After Cisplatin Plus Etoposide in Extensive-Stage Small-Cell Lung Cancer: E7593—A Phase III Trial of the Eastern Cooperative Oncology Group

Schiller, Joan H.; Adak, Sudeshna; Cella, David; DeVore, Ronald A.; Johnson, David H.

doi:10.1200/jco.2001.19.8.2114

Cited by 260 publications

(119 citation statements)

References 24 publications

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“…SCLC is an extremely aggressive malignancy, with significantly shortened doubling time, higher growth fraction, and earlier onset of remote metastasis, is usually sensitive to chemotherapy with an objective response rate of 80-90% (Schiller et al, 2001;Simon et al, 2003;Stupp et al, 2004;Socinski et al, 2006;Jemal et al, 2010). There is an intersection between SCLC and NSCLC that the WHO/IASLC classification in 1999 defined combined small cell lung carcinomas (C-SCLC).…”

Section: Introductionmentioning

confidence: 99%

Etoposide-Cisplatin Alternating with Vinorelbine-Cisplatin Versus Etoposide-Cisplatin Alone in Patients with Extensive Disease Combined with Small Cell Lung Cancer

Zhang

Qi²,

Zheng³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: The aim of this study was to evaluate the efficacy of alternating etoposide-cisplatin and vinorelbine-cisplatin (EP-NP) compared with an etoposide-cisplatin (EP) regimen for advanced combined small cell carcinomas. Materials and Methods: Histologically confirmed combined small cell carcinoma patients who met the inclusion criteria were randomly assigned (1:1) into either the EP-NP setting (group A) or the EP setting (group B). The primary endpoint was progression-free survival in patients who received at least one dose of treatment. Results: Eighty-two patients entered into this trial, 42 in group A and 40 in group B. The objective response rates in group A and group B were 42.9% and 32.5%, respectively (p=0.334). Survival analysis showed that median progression-free survival was 6.1 months in group A, which was significantly longer than the 4.1 months in group B (p=0.041). However, as to overall survival, no significant difference was found between the two groups (11.0 vs 10.1 months in groups A and B, respectively, p=0.545). No unexpected side effects were observed in either group. Conclusions: The EP-NP regimen for combined small cell carcinomas prolonged progressionfree survival compared with the EP regimen. Further clinical investigations are warranted.

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Section: Introductionmentioning

confidence: 99%

Etoposide-Cisplatin Alternating with Vinorelbine-Cisplatin Versus Etoposide-Cisplatin Alone in Patients with Extensive Disease Combined with Small Cell Lung Cancer

Zhang

Qi²,

Zheng³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…There are studies in which chemotherapy appears to enhance patients' quality of life (Thatcher et al, 1997;Stockler et al, 1998;Tannock, 1998;Geels et al, 2000;Doyle et al, 2001). Ramirez et al (1998) found that only 25% of the patients benefited from chemotherapy in her study, and there are several studies in which no improvement or even deterioration of quality of life was reported (Quantin et al, 2000;van Andel et al, 2000;Barras et al, 2001;Schiller et al, 2001). Values of patients thus become more important.…”

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confidence: 96%

Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

et al. 2003

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In palliative cancer treatment, the choice between palliative chemotherapy and best supportive care may be difficult. In the decisionmaking process, giving information as well as patients' values and preferences become important issues. Patients, however, may have a treatment preference before they even meet their medical oncologist. An insight into the patient's decision-making process can support clinicians having to inform their patients. Patients (n ¼ 207) with metastatic cancer, aged 18 years or older, able to speak Dutch, for whom palliative chemotherapy was a treatment option, were eligible for the study. We assessed the following before they consulted their medical oncologist: (1) socio-demographic characteristics, (2) disease-related variables, (3) quality-of-life indices, (4) attitudes and (5) preferences for treatment, information and participation in decision-making. The actual treatment decision, assessed after it had been made, was the main study outcome. Of 207 eligible patients, 140 patients (68%) participated in the study. At baseline, 68% preferred to undergo chemotherapy rather than wait watchfully. Eventually, 78% chose chemotherapy. Treatment preference (odds ratio (OR) ¼ 10.3, confidence interval (CI) 2.8 -38.0) and a deferring style of decision-making (OR ¼ 4.9, CI 1.4 -17.2) best predicted the actual treatment choice. Treatment preference (total explained variance ¼ 38.2%) was predicted, in turn, by patients' striving for length of life (29.5%), less striving for quality of life (6.1%) and experienced control over the cause of disease (2.6%). Patients' actual treatment choice was most strongly predicted by their preconsultation treatment preference. Since treatment preference is positively explained by striving for length of life, and negatively by striving for quality of life, it is questionable whether the purpose of palliative treatment is made clear. This, paradoxically, emphasises the need for further attention to the process of information giving and shared decision-making.

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“…These results are consistent with the results of a large, Phase III trial recently completed by the ECOG in which patients were randomized to receive single-agent topotecan or no further therapy after receiving four courses of cisplatin and etoposide. 22 No benefits of follow-up treatment with topotecan were noted, with only 7% of patients improving their response rate and with no prolongation of survival. However, maintenance oral etoposide after treatment with combined etoposide, ifosfamide, and cisplatin was shown to prolong median progression free survival (8.23 months vs. 6.5 months) and had a trend toward prolonging 2-year survival (16.2% vs. 6.7%; P ϭ 0.07) in a Hoosier Oncology Group trial.…”

Section: Discussionmentioning

confidence: 97%

Paclitaxel, carboplatin, and topotecan in the treatment of patients with small cell lung carcinoma

Hainsworth

Morrissey

Scullin³

et al. 2002

Cancer

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BACKGROUNDThe objective of this study was to evaluate the feasibility, toxicity, and efficacy of a novel three‐drug regimen containing paclitaxel, carboplatin, and topotecan followed by oral etoposide in the first‐line treatment of patients with small cell lung carcinoma.METHODSOne hundred five patients with previously untreated, limited stage or extensive stage small cell lung carcinoma were treated in this multicenter, community‐based, Phase II trial. All patients received paclitaxel 135 mg/m2 by 1‐hour intravenous (IV) infusion on Day 1, carboplatin at an area under the serum concentration‐time curve of 5.0 IV on Day 1, and topotecan 0.75 mg/ m2 IV on Days 1–3. The treatment regimen was repeated at 21‐day intervals for 4 courses. Patients with limited stage disease also received radiation therapy (45 grays [Gy]; in single daily fractions of 1.8 Gy) beginning concurrently with the third course of chemotherapy. Patients who had an objective response or stable disease after 4 courses of combined paclitaxel, carboplatin, and topotecan then received 3 courses of oral etoposide (50 mg alternating with 100 mg for 10 consecutive days) repeated at 21‐day intervals.RESULTSTreatment with paclitaxel, carboplatin, and topotecan produced response rates of 88% and 93% in patients with extensive stage disease and limited stage disease, respectively. The median survival for patients with extensive stage and limited stage disease was 8.3 months and 17.2 months, respectively. The addition of oral etoposide was feasible, but there was no suggestion that it prolonged remission. This three‐ drug regimen was associated with acceptable toxicity in patients with a good performance status, although it was tolerated very poorly by patients with an Eastern Cooperative Oncology Group performance status of 2; 5 of 12 patients (42%) had treatment‐related deaths.CONCLUSIONSAlthough this three‐drug regimen was active in the treatment of patients with small cell lung carcinoma, it was more toxic than standard platinum and etoposide regimens and provided no apparent improvement in efficacy. Further investigation of topotecan as a component of first‐line therapy should focus on two‐drug combination regimens in which the topotecan dose can be optimized. Routine use of three‐drug regimens in patients with small cell lung carcinoma should await demonstration of superiority in randomized trials. Cancer 2002;94:2426–33. © 2002 American Cancer Society.DOI 10.1002/cncr.10508

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Topotecan Versus Observation After Cisplatin Plus Etoposide in Extensive-Stage Small-Cell Lung Cancer: E7593—A Phase III Trial of the Eastern Cooperative Oncology Group

Cited by 260 publications

References 24 publications

Etoposide-Cisplatin Alternating with Vinorelbine-Cisplatin Versus Etoposide-Cisplatin Alone in Patients with Extensive Disease Combined with Small Cell Lung Cancer

Etoposide-Cisplatin Alternating with Vinorelbine-Cisplatin Versus Etoposide-Cisplatin Alone in Patients with Extensive Disease Combined with Small Cell Lung Cancer

Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

Paclitaxel, carboplatin, and topotecan in the treatment of patients with small cell lung carcinoma

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