Irinotecan in cancers of the lung and cervix

Irinotecan is active as a single agent in advanced non-small cell lung cancer (NSCLC), with overall response rates (ORRs) of 13-32% reported in phase II trials. In the first-line treatment of stage III/IV NSCLC, phase II studies have suggested that the combination of irinotecan with cisplatin can achieve response rates of 29-75%, which is greater than achieved with older platinum-containing combinations. Neutropenia and diarrhea are the dose-limiting toxicities. In small cell lung cancer (SCLC), irinotecan alone has achieved ORRs of 16-47% in previously treated SCLC, which is higher than expected with oral etoposide. Studies with irinotecan in combination with cisplatin or etoposide have reported responses of up to 79%. Irinotecan is active in cervical cancer patients whose metastases are outside the area of previous irradiation (ORR 24%) and a major phase II/III study is currently comparing irinotecan as single agent or in combination with cisplatin against a reference cisplatin arm.