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Teniposide in the treatment of small cell lung cancer: a review
H H Hansen1, P Dombernowsky, M Hansen
1Department of Oncology, Finsen Institute/Rigshospitalet, Copenhagen, Denmark.
Abstract:
The epipodophyllotoxin derivatives teniposide and etoposide have been under clinical investigation for over 15 years. Although etoposide has been established as one of the most active compounds in the treatment of small cell lung cancer (SCLC), teniposide has received little attention. The results of seven phase II studies evaluating response rate and duration of response to teniposide in 10 previously treated and 102 untreated patients showed response rates of 21% and 58%, respectively. The most frequently used dosage schedule was 60 mg/m2 intravenously daily for 5 days every 3 weeks. The following are factors influencing the response rate and duration of response to teniposide: performance status; prior weight loss; prior chemotherapy exposure, including prior treatment with etoposide; stage; and effectiveness of prior chemotherapy, including time from last administration. Preliminary analyses from a study comparing the efficacy of teniposide with that of etoposide suggest that teniposide may be more effective in previously untreated patients with SCLC who are 70 years of age or older. The preliminary data, however, indicate that equivalent doses of teniposide cause more cases of leukopenia than etoposide. Before a final conclusion can be drawn, the results from an ongoing study using teniposide and etoposide at equitoxic doses must be evaluated.
Insights
Teniposide shows promise for treating small cell lung cancer (SCLC), particularly in older, untreated patients. However, further research is needed to compare its efficacy and toxicity against etoposide at equivalent doses.
Area of Science:
- Oncology
- Pharmacology
Background:
- Etoposide is a well-established treatment for small cell lung cancer (SCLC).
- Teniposide, a related epipodophyllotoxin derivative, has been less extensively studied in SCLC.
- Clinical investigation of these derivatives has spanned over 15 years.
Purpose of the Study:
- To evaluate the response rates and duration of response to teniposide in patients with SCLC.
- To compare the efficacy and toxicity of teniposide with etoposide in SCLC treatment.
Main Methods:
- Analysis of seven Phase II studies involving teniposide in 112 SCLC patients (10 previously treated, 102 untreated).
- Evaluation of response rates and duration of response based on various patient and treatment factors.
- Preliminary comparative analysis of teniposide versus etoposide efficacy and toxicity.
Main Results:
- Teniposide demonstrated response rates of 21% in previously treated and 58% in untreated SCLC patients.
- Factors influencing response include performance status, weight loss, prior chemotherapy, stage, and prior etoposide treatment.
- Preliminary data suggest teniposide may be more effective in untreated SCLC patients aged 70+.
- Equivalent doses of teniposide were associated with higher rates of leukopenia compared to etoposide.
Conclusions:
- Teniposide exhibits significant activity in untreated SCLC patients, with potential advantages in older populations.
- Further investigation, including studies at equitoxic doses, is necessary to definitively compare teniposide and etoposide.
- Toxicity profiles, particularly leukopenia, require careful consideration when comparing the two agents.