NASHVILLE, Tennessee—Irinotecan (Camptosar)/cisplatin (Platinol) combination therapy was significantly more effective and less toxic than standard etoposide(Drug information on etoposide) (VePesid)/cisplatin in phase II trials, according to Alan B. Sandler, MD. The combination is now being tested in larger clinical studies. These confirmatory studies will use a 21-day cycle of irinotecan(Drug information on irinotecan)/cisplatin rather than the 28-day cycle used in preliminary studies.
Although small-cell lung cancer (SCLC) is typically quite chemosensitive, most patients relapse and 90% die within 2 years of relapse. "Early metastatic involvement is common, and 60% to 70% of patients present with extensive essentially incurable disease," Dr. Sandler said. He is associate professor of medicine and medical director of thoracic oncology at Vanderbilt University Medical Center in Nashville, Tennessee.
Current Outcomes Dismal
Etoposide has been considered the most active single agent, and most widely used combinations are etoposide based. Dr. Sandler said that outcomes with current standard regimens are dismal, with median overall survival of only 6 to 11 months and 2-year survival of 10% to 20% in patients with extensive disease.
"Prior to 2000, phase III trials in extensive SCLC showed no convincing data that any one regimen was superior," Dr. Sandler said. "Although somewhat longer median survival occurred with etoposide, ifosfamide(Drug information on ifosfamide) (Ifex), and cisplatin(Drug information on cisplatin) (VIP), it has not become the standard of care because of the associated toxicity."
Single-Agent Activity
A number of new agents have significant single-agent activity in either first-line or second-line use. Dr. Sandler said that work with irinotecan has been carried forward in combination therapy, mostly in Japan. Kudoh and coworkers reported data on a phase II study of weekly irinotecan plus cisplatin as first-line therapy for patients with either limited or extensive SCLC.
