Concurrent chemoradiotherapy for limited-disease small cell lung cancer in elderly patients aged 75 years or older

Background: The optimal treatment for limited-disease small cell lung cancer(LD-SCLC) in patients aged 75 years or older remains unknown. Methods: Elderly patients with LD-SCLC who were treated with chemoradiotherapywere retrospectively reviewed to evaluate their demographiccharacteristics and the treatment delivery, drug toxicitiesand antitumor efficacy. Results: Of the 94 LD-SCLC patients treated with chemotherapy and thoracicradiotherapy at the National Cancer Center Hospital between1998 and 2003, seven (7.4%) were 75 years of age or older. Allof the seven patients were in good general condition, with aperformance status of 0 or 1. Five and two patients were treatedwith early and late concurrent chemoradiotherapy, respectively.While the four cycles of chemotherapy could be completed inonly four patients, the full dose of radiotherapy was completedin all of the patients. Grade 4 neutropenia and thrombocytopeniawere noted in seven and three patients, respectively. Granulocyte-colonystimulating factor support was used in five patients, red bloodcell transfusion was administered in two patients and platelettransfusion was administered in one patient. Grade 3 or moresevere esophagitis, pneumonitis and neutropenic fever developedin one, two and three patients, respectively, and one patientdied of radiation pneumonitis. Complete response was achievedin six patients and partial response in one patient. The mediansurvival time was 24.7 months, with three disease-free survivorsfor more than 5 years. Conclusion: Concurrent chemoradiotherapy promises to provide long-term benefitwith acceptable toxicity for selected patients of LD-SCLC aged75 years or older.     

Treatment of etoposide capsule combined with cisplatin or carboplatin in elderly patients with small cell lung cancer

We aimed to explore the efficacy and safety of etoposide capsule combined with cisplatin or carboplatin in the treatment of elderly patients with small cell lung cancer （SCLC）. Methods： From October 2011 to November 2013, 32 elderly patients （71-79 years old） with histopathologically confirmed SCLC in General Hospital of Shenyang Military Region （China） were enrolled in the research. The patients were administrated with lastet capsule 150-175 mg, dl-5, combined with cisplatin 20 mg/m^2 dl-3 or carbopiatin AUC = 5, applied over 2 days. Twenty-one days were 1 treatment cycle. Results：After treatments, 2 cases acquired complete response （CR）, 19 cases acquired partial response （PR）, 8 cases acquired stable disease （SD）, and 3 cases had progression of disease （PD）. The objective response rate was 65.6% （21/32）, disease control rate was 90.6% （29/32）. The median time of progression-free survival （PFS） was 6.9 months, the median survival time was 14.0 months, and 1 year survival rate was 62.4%. The main adverse reactions of 1/11 leukopenia and gastrointestinal reaction were observed. Conclusion： Etoposide capsule combined with cisplatin or carboplatin therapy have curative effect and good tolerance in elderly patients with SCLC.     

Combination chemotherapy with carboplatin and weekly Paclitaxel in patients with advanced non-small cell lung cancer

BACKGROUND: The objective of this study was to evaluate the efficacy and toxicity of carboplatin plus weekly paclitaxel as first-line therapy in patients with advanced non-small cell lung cancer (NSCLC). METHODS: Forty-nine patients were analyzed retrospectively. Every 4 weeks patients received 70 mg/m(2)paclitaxel on days 1, 8, and 15, and AUC 5-6 carboplatin on day 1. RESULTS: A median of four cycles (range, 1-7) was administered. Twenty-four patients had a partial response, and the overall response rate was 48.9%. The median survival time was 12.8 months and the 1-year survival was 50.7%. Overall toxicities were mild. The most common toxicity was neutropenia, grade 3/4 in 32% of the patients. Grade 3/4 hematologic toxicities included anemia (16%) and thrombocytopenia (8%). Grade 3/4 non-hematologic toxicities included febrile neutropenia (2%), pneumonia (10%) and interstitial pneumonia (2%). Grade 2 peripheral neuropathy was seen in one patient (2%). CONCLUSIONS: These results demonstrate that this regimen is an active and tolerable treatment for patients with advanced NSCLC. It is suggested that this weekly regimen should be considered as one of the standard therapies for future chemotherapy in advanced NSCLC.     

异环磷酰胺、鬼臼乙叉甙、卡铂方案治疗晚期非小细胞肺癌的疗效观察

目的：观察异环磷酰胺、鬼臼乙叉甙、卡铂（IEC）方案治疗晚期非小细胞肺癌的疗效和毒副反应。方法：33例晚非小细胞肺癌患者接受IEC方案化疗。观察全组患者的近、远期疗效及毒副反应。结果：全组患者PR7例，NC24例，PD2例，有效率为21．2％（7／33，95％CI：7．3％－35．1％）；中位生存期7．8月（95％CI：6．2－9．4月）；1年生存率为20．0％（95％CI：6．0％－34．0％）。主要毒副反应为较严重的血液学毒性，Ⅲ-Ⅳ度白细胞减少、血少板减少及血红蛋白减少发生率分别为51．5％（17／33）、18．2％（6／33）和30．3％（10／33）。60岁以上组Ⅲ-Ⅳ度白细胞减少发生率（P＝0．024）和血小板发生率（P＝0．037）明显高于60岁以下组。结论：IEC方案对晚期非小细胞肺癌有效；主要毒副反应为较严重的血液毒性，尤其高发于老年人，因此对于老年患者最好在G－CSF或GM－CSF的支持下进行治疗。     

CPE和CE方案治疗小细胞肺癌的疗效比较

目的　评价CPE(卡铂、顺铂、足叶乙甙)和CE(卡铂、足叶乙甙)方案治疗小细胞肺癌(SCLC)的疗效和毒性。方法　应用CPE和CE方案治疗32例SCLC患者,每组16例,CPE组和CE组中的复治病例分别为10例和7例。结果　CPE组和CE组的有效率分别为81.3%(13/16)和87.5%(14/16)(P>0.05)。CPE组与CE组中的复治病例有效率分别为60%(6/10)和42.9%(3/7)(P<0.05)。CPE组与CE组的骨髓抑制率分别为71.9%和93.8%(P<0.05)。两组间其它毒性反应差异无显著性(P>0.05)。结论　CPE方案治疗SCLC的疗效与CE方案相近,但CPE的骨髓抑制明显较CE轻;CPE对复治病例的疗效优于CE。     

Combination chemotherapy with newly-developed cytostatics for disseminated small cell lung cancer

The paper discusses the results of phase II clinical trials of chemotherapy regimens using newly-developed cytostatics for disseminated small cell lung cancer. Taxotere (docetaxel)/cisplatin and campto(irinotecan)/cisplatin were investigated as first-line treatment. Doxorubicin and vincristine in combinations with a novel antitumor cytostatic aranoza were studied for application as second-line treatment. Safety and immediate- and end results were reviewed. Taxotere (docetaxel)/cisplatin and campto(irinotecan)/cisplatin regimens were compared.     

Combination chemotherapy with carboplatin, etoposide, and vincristine as first-line treatment in small-cell lung cancer.

PURPOSE: The antineoplastic activity of carboplatin and etoposide may be improved by the addition of vincristine (CEV) because of its low myelosuppressive potential and its activity in small-cell lung cancer (SCLC). A phase II study with CEV was carried out. PATIENTS AND METHODS: One hundred twenty-one untreated patients with SCLC (63 with limited disease [LD], 58 with extensive disease [ED]) were treated with a combination of 300 mg/m2 intravenous (IV) on day 1, etoposide 140 mg/m2 IV daily on days 1 to 3, and vincristine 1.4 mg/m2 IV on days 1, 8, and 15 every 4 weeks. RESULTS: A 90% rate overall response rate including 56% complete responses (CRs) was achieved in LD and an 83% overall response rate including 35% CRs was observed in ED. Median survival time was 13 months in limited disease and 9.5 months in extensive disease. The 24 and 36 months survival rates were 29% in LD and 9% in ED. Myelosuppression was the main form of toxicity. CONCLUSION: The combination of CEV is a new active and well-tolerated regimen in the treatment of SCLC. Prospective randomized studies of CEV with conventional chemotherapy are warranted.     

The benefit of chemotherapy in elderly patients with small cell lung cancer

Elderly patients with small cell lung cancer derive a statistically significant benefit from the administration of combination chemotherapy. Numerous clinical trials have demonstrated high response rates and impressive median survivals with carboplatin and etoposide, cisplatin and etoposide, and other regimens. All elderly patients with small cell lung cancer should be evaluated by a medical oncologist to determine whether they are candidates for chemotherapy.     

Randomized comparison of lobaplatin plus etoposide and cisplatin plus etoposide chemotherapy in patients with extensive-stage small cell lung cancer

Objective

To compare the efficacy and safety of Lobaplatin plus Etoposide (EL) and Cisplatin plus Etoposide (EP) regimens in chemonaive with extensive-stage small-cell lung cancer (SCLC).

Methods

Between July 2010 and July 2011, a total of 62 patients with extensive-stage small-cell lung cancer who received initial treatment in our hospital and 309 hospital of PLA. 31 patients were randomly assigned to the EL Group: Lobaplatin was given intravenously at a dose of 30 mg/m² on day 1 and Etoposide 100 mg/m² on days 1 to 3 of 21-day cycles for a maximum of six cycles. Another 31 patients were assigned to the EP Group: Cisplatin was given intravenously at a dose of 75 mg/m² on day 1 and Etoposide 100 mg/m² on days 1 to 3 of 21-day cycles for a maximum of six cycles. We evaluated the efficacy, overall response rate (ORR), disease control rate (DCR), the progression-free survival (PFS) and toxicity between the patients of the two groups.

Results

All 62 patients were eligible. In the EL group, 2 (6.5%) patients had complete response, 20 (64.5%) patients had partial response, 5 (16.1%) patients had stable disease and 4 (12.9%) patients had progress disease. In the EP group, 2 (6.5%) patients had complete response, 22 (70.9%) patients had partial response, 4 (12.9%) patients had stable disease and 3 (9.7%) patients had progress disease. The ORR of EL and EP group were 70.9% and 77.4%, respectively, showing no significant difference (P = 0.562). The DCR of both groups were 87% and 90%, respectively, showing no significant difference (P = 0.688). Median PFS of patients with EL and EP regimens were 5.5 months and 5 months, respectively, showing no significant difference (P = 0.637). Adverse events were observed in all 62 patients. Grade 1 to 4 anemia was higher in the EP group than in EL group, showing significant difference (P = 0.02). Grade 3 and 4 thrombocytopenia was seen in 4 patients (12.9%) in EL group and 1 patient (3.2%) in EP group. Although one patient had platelet transfusion owing to Grade 4 thrombocytopenia in EL group, no significant difference (P = 0.637) were shown. The incidence of nausea/vomiting was higher in the EP group than in the EL group (96.7% vs 51.6%, P = 0.00).

Conclusion

The EL regimen is an effective and low-toxicity chemotherapy and no inferior to EP regimen in treatment response, therefore, EL regimen maybe is a good choice for patients with extensive-stage SCLC.     

Combination cyclophosphamide and etoposide in treatment of small cell lung cancer

Thirty-one patients with histologically proven small cell lung cancer were treated with cyclophosphamide 1 g m-2 and etoposide (VP16-213) 125 mg m-2 both intravenously on day 1 followed by etoposide 250 mg m-2 orally on days 2-3 for a maximum of six courses at 3 weekly intervals. Fourteen patients had limited and 17 patients had extensive disease. Twenty-five patients were evaluable for response. Objective response was observed in 18 patients (58%) with 6 (19%) complete and 12 (39%) partial responses. Median survival of the entire group of patients was 30 weeks. There was significant survival benefit among the responders (P less than 0.005) when compared with non-responders. One patient (3.3%) developed grade 4 while 60% of patients developed grade 1-2 haematological toxicity. Other side effects were relatively mild. We conclude that combination cyclophosphamide and etoposide was active in small cell lung cancer and relatively well tolerated.     

Combination of topotecan and etoposide as a salvage treatment for patients with recurrent small cell lung cancer following irinotecan and platinum first-line chemotherapy

Purpose The efficacy and safety of a combined regimen of topotecan and etoposide was tested in patients with relapsed or refractory small-cell lung cancer. Patients and methods From October 2003 to May 2005, 23 patients who have failed to the previous irinotecan and platinum chemotherapy received intravenous topotecan 1 mg/m² (day 1–5) and etoposide 80 mg/m² (day 1–3). Treatment was repeated every 21 days for a maximum of 6 cycles. Results Twelve patients were refractory to first-line chemotherapy. Seventeen patients (73.9%) were male and the median age was 63 years. ECOG performance status was 0–1 in 13 (56.5%) patients. The median cycles of chemotherapy was three. Twenty-one patients were assessable for response evaluation. The overall response rate was 17.4% (0 CR, 4 PR, 7 SD, 10 PD) under the intent-to-treat analysis. Two sensitive case patients and two refractory case patients achieved partial response. After a median follow-up of 20.8 months, median progression free survival was 4.7 months and median overall survival was 9.5 months. The estimated 1-year survival rate was 38.7%. All patients were assessable for toxicity and major toxicities were myelosuppression. Grade 3/4 neutropenia and thrombocytopenia occurred in 18 (78.3%) and 12 (52.2%) patients, respectively. Grade 3/4 febrile neutropenia occurred in two patients (8.7%) and infection in three patients (13.0%). There was one treatment-related death due to pneumonia. Conclusion This salvage regimen showed modest efficacy and manageable toxicities. Further study will be required in recurrent SCLC patients pretreated irinotecan and platinum.     

足叶乙甙联合铂类一线化疗后复发的小细胞肺癌二线化疗的临床研究

目的：本研究旨在分析敏感性复发及难治性复发的小细胞肺癌的二线化疗效果。方法：2003年1月-2006年3月经足叶乙甙联合铂类一线化疗后复发的小细胞肺癌（SCLC）共64例,其中敏感性患者复发31例,难治性患者复发33例。对难治性复发或敏感性复发时间少于6月者,采用紫杉类或伊立替康单药化疗;对敏感性复发时间大于6月者仍采用原一线方案或更改为紫杉类或伊立替康单药化疗。结果：64例患者进行了二线化疗,有57例患者可评价疗效,二线治疗总有效率22．8％,中位疾病进展时间（mTTP）15．1周,中位生存期（MST）7．2月。敏感性复发组及难治性复发组的有效率（CR＋PR）分别为37．9％和7．1％（P〈0．01）,mTTP分别为15．9周和10．4周（P〈0．05）,MST分别为9．0月和6．0月（P〈0．05）。骨髓抑制为二线化疗的主要不良反应,敏感性复发组及难治性复发组G3／4级白细胞减少发生率分别为41．9％和42．4％,G3／4级血小板减少发生率分别为22．6％和30．3％,两组不良反应无明显差异（P〉0．05）。结论：足叶乙甙联合铂类一线化疗后复发的小细胞肺癌采用二线化疗有部分病例仍有效,特别是对于敏感性复发的患者。     

Adriamycin, cisplatin, and etoposide combination chemotherapy for small cell lung cancer

Twenty-three patients with small cell lung cancer (11 with limited disease and 12 with extensive disease) who had not received previous chemotherapy were treated with a combination of adriamycin (30 mg/m2, i.v., on day 1), cisplatin (80 mg/m2, i.v., on day 1) and etoposide (70 mg/m2, i.v., on day 1-5). This chemotherapy regimen was repeated at 3- or 4-week intervals for 3 to 5 treatment cycles. Among 22 evaluable patients, 5 showed complete response and 17 had a partial response (response rate 100%). The median response duration of 12 extensive disease patients was 21 months. There were 5 survivors for more than 2 years. Toxicity included moderate to severe hematologic toxicity, alopecia, nausea and vomiting. This combination chemotherapy appears to be optimal for the treatment of small cell lung cancer.     

Phase II trial of carboplatin plus oral etoposide for elderly patients with small-cell lung cancer.

A phase II trial was conducted to evaluate the efficacy and toxicity of the Egorin''s carboplatin dosing formula with 14-day oral etoposide in 38 elderly patients with small-cell lung cancer (SCLC). The overall response rate was 81%. Median survival times were 15.1 months for 16 limited-disease (LD) and 8.6 months for 22 extensive-disease (ED) patients. Myelosuppression was the principal side-effect. This regimen is an active regimen in the treatment of elderly SCLC patients.     

Successful chemotherapy with carboplatin and docetaxel for an elderly patient with advanced non-small cell lung cancer

A 79-year-old man was admitted to our hospital with right hypochondrium pain. His chest X-ray and CT scan showed a mass lesion on the left upper lobe, and multiple metastases in the liver. The diagnosis was non-small cell carcinoma of the lung. He received 4 courses of combined chemotherapy of carboplatin and docetaxel every 4 weeks. At the end of 4 courses, a partial response was achieved. Two courses of a in similar regimen were added at the time of a later recurrence, and the effect was a partial response. Carboplatin+docetaxel combined chemotherapy, which can be conducted relatively safely on an outpatient basis, may be an effective treatment for non-small cell lung cancer in the elderly.