PACLITAXEL AS THIRD-LINE CHEMOTHERAPY FOR REFRACTORY SMALL-CELL LUNG CANCER TO BOTH ETOPOSIDE- AND CAMPTOTHECIN-BASED CHEMOTHERAPY

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Abstract

Background

Paclitaxel has been shown to have clinical activity in the treatment of small-cell lung cancer (SCLC). However, its role as third-line chemotherapy for SCLC has not been evaluated.

Methods

Patients with refractory SCLC who were treated with a paclitaxel-based regimen as third-line chemotherapy between 2005 and 2010 in the Seoul National University Bundang Hospital were reviewed retrospectively. Forty patients who were treated with previous two chemotherapy regimens (etoposide- and camptothecin-based chemotherapy) were included.

Results

Of 40 patients included, male was 35 (87.5%), and the median age was 67 years (range, 35–86 years). The median time of systemic chemotherapy was 4 weeks (range, 1.3–23.1 weeks). Most (n = 31; 77.5%) received cisplatin–etoposide as first-line therapy, and camptothecins such as irinotecan or topotecan as second-line therapy. The rest received etoposide-based chemotherapy after failure of irinotecan-based chemotherapy. Thirty-four patients were evaluable for response. Eight patients (23.5%) achieved partial remission and 9 (26.5%) had stable disease. The median PFS and OS were 2.5 months (95% CI, 1.2–3.8 months) and 5.9 months (95% CI, 3.5–8.3 months), respectively. The predictive factor to OS were performance status (PS) (<2 versus ≥2; P = 0.001), the presence of liver metastasis (P < 0.0001) and number of metastatic sites (<3 versus ≥3; P = 0.047) in univariate analysis. PS and liver metastasis also remained significant in multivariate analysis. The hematologic toxicity of grade 3 or 4 was 20% for neutropenia, and 10% for thrombocytopenia. Six patients experienced severe infection (≥ grade 3) and three of them died of it. Other common non-hematological toxicities were peripheral neuropathy, mild AST and ALT elevation.

Conclusions

Paclitaxel-based chemotherapy showed modest activity in SCLC patient refractory to both etoposide- and camptothecin-based chemotherapies. Myelosuppression and related infection was the most common and limiting toxicity. PS and liver metastasis were the predictive of survival after paclitaxel therapy.

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