br Results A total of patients
Results: A total of 24 (7.5%) patients (male, n ¼ 21; female, n ¼ 3; median age, 67 years; performance status, 0–1/Z2, 15/8 patients; limited/extensive disease, 6/15 patients; sensitive/refractory relapse, 3/21 patients) were treated with carboplatin plus paclitaxel. This regimen was chosen due to Vorinostat lung disease (ILD) (n ¼ 17), radiation pneumonitis (n ¼ 3), combination with palliative radiation therapy (n ¼ 2), and the presence of other cancers (n ¼ 2). The response rate was 33.3%, and the disease control rate was 62.5%. The median PFS and overall survival were 4.1 and 8.7 months, respectively. Grade 3/4 hematologic toxicities observed included neutropenia (54.2%), anemia (4.2%), and thrombocytopenia (8.3%). With the exception of grade 3 neuropathies (n ¼ 2), non-hematologic toxicities were mild. No patients experienced an acute exacerbation of ILD.
Conclusion: A combination of carboplatin plus paclitaxel as second-line chemotherapy is effective and feasible in patients with SCLC, especially in those with ILD.
& 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
Abbreviations: SCLC, small cell lung cancer; PFS, progression-free survival; ILD, interstitial lung disease; CBDCA, carboplatin; PTX, paclitaxel
Small cell lung cancer (SCLC) is a common neuroendocrine tumor that accounts for 15–20% of all cases of lung cancer. Around two-thirds of patients at diagnosis have extensive disease with metastases . SCLC is characterized by a high rate of invasion and rapid cellular proliferation. SCLC also shows great sensitivity to chemotherapy and radiotherapy; however, the duration of response is relatively short. The typical first-line treatment for this disease is platinum doub-let chemotherapy combined with irinotecan or etoposide. Patients with limited disease are treated with platinum plus etoposide when radiation therapy is added with curative intent.
Several meta-analyses of regimens for patients with pre-viously untreated extensive-stage SCLC have been under-taken [2,3]. The two-drug combination of etoposide and cisplatin remains the standard of care for SCLC . In most cases, the administration of chemotherapy is able to prolong the duration of survival and improve symptoms of patients with SCLC. However, there are no drugs that can be con-fidently prescribed to treat relapsed SCLC, which has a very poor prognosis. Agents that are frequently used to treat SCLC in Japan include amrubicin or the same regimen with first-line treatment as second-line treatments . Topotecan and irinotecan are other agents that have been used in second-line treatment. Since 24% of patients with relapsed SCLC responded to topotecan , this is often used, particularly as it was the sole regimen to show efficacy in a phase III trial. Elsewhere, several agents, including paclitaxel, docetaxel, vinorelbine, and gemcitabine, have been studied in SCLC, but none have been investigated in phase III studies.
In clinical practice, some patients cannot be treated with chemotherapeutic agents due to a poor performance status (PS) or disease complications. In particular, some patients have interstitial lung disease (ILD), which seems to be associated with the occurrence of lung carcinoma. From 6–17% of lung cancer patients have been shown to have combined ILD . An exacerbation of ILD may bring on a fatal state at any time. It is well known that patients with pre-existing ILD may experience an acute exacerbation when treated with cytotoxic chemotherapy. Although reports are lacking on the safety of administering chemotherapeutic agents to patients with SCLC and ILD, etoposide and pacli-taxel (PTX) are relatively safe drugs for the treatment of non-small cell lung cancer (NSCLC) .
We focused on the administration of paclitaxel for the treatment of relapsed SCLC. The objectives of the present study were to analyze the frequency at which carboplatin (CBDCA) plus PTX was administered as after second-line treatment, and to assess its efficacy and safety.