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Etoposide and split-dose cisplatin in small-cell lung cancer
H Wilke1, W Achterrath, H J Schmoll
1Medical School, Department of Hematology/Oncology, Hannover, F.R.G.
American Journal of Clinical Oncology
|October 1, 1988
Summary
This study shows that combining etoposide and cisplatin chemotherapy with radiation therapy offers a high response rate and extended survival for small-cell lung cancer (SCLC) patients. The treatment regimen demonstrated significant efficacy in both limited and extensive SCLC stages.
Area of Science:
- Medical Oncology
- Clinical Trials
- Pulmonology
Background:
- Small-cell lung cancer (SCLC) presents a significant therapeutic challenge.
- Effective treatment strategies for SCLC, particularly for extensive disease, are continuously sought.
- Combination chemotherapy and radiotherapy are standard treatment modalities for SCLC.
Purpose of the Study:
- To evaluate the efficacy and toxicity of a combination chemotherapy regimen of etoposide and cisplatin, followed by radiotherapy in responding patients with small-cell lung cancer.
- To determine the overall objective response rate, complete response rate, remission duration, and survival outcomes.
- To assess the safety profile of the treatment regimen, including hematologic and other toxicities.
Main Methods:
- Forty-seven untreated SCLC patients received etoposide (170 mg/m2 i.v., days 3-5) and cisplatin (50 mg/m2 i.v., days 1 and 7).
- Responding limited disease patients received four cycles of chemotherapy followed by 50 Gy irradiation to primary sites and regional nodes.
- Responding extensive disease patients received four to six cycles of chemotherapy; complete responders received prophylactic cranial irradiation (PCI).
Main Results:
- An overall objective response rate of 94% (44/47) was observed, with a complete response (CR) rate of 57% (27/47).
- Median remission duration was 13 months (26 months for limited disease, 12 months for extensive disease).
- Median survival was 16 months overall (28 months for limited disease, 15 months for extensive disease).
- Hematologic toxicity was notable, with grade 3/4 leukopenia in 30/47 and grade 3/4 thrombocytopenia in 6/47 patients. Four severe infections occurred in neutropenic patients; one treatment-related death occurred due to progressive neurologic dysfunction post-PCI.
Conclusions:
- The etoposide and cisplatin combination chemotherapy, integrated with radiotherapy, achieves high complete response rates in SCLC patients.
- This treatment schedule significantly prolongs remission duration and survival, particularly in patients with extensive SCLC.
- The regimen is associated with manageable toxicity, primarily hematologic, and demonstrates a favorable risk-benefit profile for SCLC treatment.