Tags

Type your tag names separated by a space and hit enter

Second-line chemotherapy in recurrent small cell lung cancer. Results from a crossover schedule after primary treatment with cisplatin and etoposide (EP-regimen) or cyclophosphamide, epirubicin, and vincristin (CEV-regimen).
Lung Cancer 2005; 48(2):251-61LC

Abstract

PURPOSE

To evaluate the benefit of crossover chemotherapy with etoposide and cisplatin (EP) versus cyclophosphamide, epirubicin, vincristine (CEV) at relapse after primary treatment with the opposite regimen in patients with small cell lung cancer (SCLC). Further, to compare the crossover group with patients not receiving chemotherapy.

PATIENTS AND METHODS

Among 286 patients diagnosed with relapse after first-line chemotherapy, 120 patients received second-line chemotherapy and 166 patients received best supportive care. Fifty-six patients received EP after previous treatment with CEV, 52 received CEV after EP, and 12 patients were re-treated with the same regimen. Possible prognostic factors in the crossover group were identified at time for first-line chemotherapy and at relapse. The EP therapy comprised five courses of etoposide 100 mg/m(2) IV and cisplatin 75 mg/m(2) IV on day 1, followed by oral etoposide 200 mg/m(2) daily on day 2-4. The CEV-regimen was five courses of epirubicin 50 mg/m(2), cyclophosphamide 1000 mg/m(2), and vincristine 2 mg, all IV on day 1.

RESULTS

Patients administered second-line chemotherapy lived significantly longer with median survival 5.3 months compared to 2.2 months in patients with best supportive care only (P<0.001). The best supportive care patients had significantly worse PS status and more resistant disease. The crossover treatment group was well balanced regarding possible prognostic factors prior to initial treatment and at recurrence. No difference in survival was found (P=0.71). Univariate analysis revealed PS at recurrence, objective tumour response from initial chemotherapy, disease stage at first-line, LDH-, NSE-, and ALP at first-line to be significant prognostic factors for survival in the second-line setting. In a multivariate analysis, only PS at time of recurrence remained an independent prognostic factor (P<0.0001).

CONCLUSION

Patients administered second-line chemotherapy had significantly longer survival than patients administered best supportive care. However, this difference can be explained by more negative prognostic factors in the best supportive care group. No survival difference between EP and CEV crossover chemotherapy was found. Multivariate analysis revealed PS at time of relapse as the only independent predictor of survival in the crossover recurrent SCLC group.

Authors+Show Affiliations

Department of Oncology, St. Olavs Hospital, University Hospital of Trondheim, N-7006 Trondheim, Norway. stein.sundstrom@stolav.no

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15829326

Citation

Sundstrøm, Stein, et al. "Second-line Chemotherapy in Recurrent Small Cell Lung Cancer. Results From a Crossover Schedule After Primary Treatment With Cisplatin and Etoposide (EP-regimen) or Cyclophosphamide, Epirubicin, and Vincristin (CEV-regimen)." Lung Cancer (Amsterdam, Netherlands), vol. 48, no. 2, 2005, pp. 251-61.
Sundstrøm S, Bremnes RM, Kaasa S, et al. Second-line chemotherapy in recurrent small cell lung cancer. Results from a crossover schedule after primary treatment with cisplatin and etoposide (EP-regimen) or cyclophosphamide, epirubicin, and vincristin (CEV-regimen). Lung Cancer. 2005;48(2):251-61.
Sundstrøm, S., Bremnes, R. M., Kaasa, S., Aasebø, U., & Aamdal, S. (2005). Second-line chemotherapy in recurrent small cell lung cancer. Results from a crossover schedule after primary treatment with cisplatin and etoposide (EP-regimen) or cyclophosphamide, epirubicin, and vincristin (CEV-regimen). Lung Cancer (Amsterdam, Netherlands), 48(2), pp. 251-61.
Sundstrøm S, et al. Second-line Chemotherapy in Recurrent Small Cell Lung Cancer. Results From a Crossover Schedule After Primary Treatment With Cisplatin and Etoposide (EP-regimen) or Cyclophosphamide, Epirubicin, and Vincristin (CEV-regimen). Lung Cancer. 2005;48(2):251-61. PubMed PMID: 15829326.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second-line chemotherapy in recurrent small cell lung cancer. Results from a crossover schedule after primary treatment with cisplatin and etoposide (EP-regimen) or cyclophosphamide, epirubicin, and vincristin (CEV-regimen). AU - Sundstrøm,Stein, AU - Bremnes,Roy M, AU - Kaasa,Stein, AU - Aasebø,Ulf, AU - Aamdal,Steinar, AU - ,, Y1 - 2004/12/15/ PY - 2004/03/18/received PY - 2004/10/20/revised PY - 2004/10/25/accepted PY - 2005/4/15/pubmed PY - 2005/7/20/medline PY - 2005/4/15/entrez SP - 251 EP - 61 JF - Lung cancer (Amsterdam, Netherlands) JO - Lung Cancer VL - 48 IS - 2 N2 - PURPOSE: To evaluate the benefit of crossover chemotherapy with etoposide and cisplatin (EP) versus cyclophosphamide, epirubicin, vincristine (CEV) at relapse after primary treatment with the opposite regimen in patients with small cell lung cancer (SCLC). Further, to compare the crossover group with patients not receiving chemotherapy. PATIENTS AND METHODS: Among 286 patients diagnosed with relapse after first-line chemotherapy, 120 patients received second-line chemotherapy and 166 patients received best supportive care. Fifty-six patients received EP after previous treatment with CEV, 52 received CEV after EP, and 12 patients were re-treated with the same regimen. Possible prognostic factors in the crossover group were identified at time for first-line chemotherapy and at relapse. The EP therapy comprised five courses of etoposide 100 mg/m(2) IV and cisplatin 75 mg/m(2) IV on day 1, followed by oral etoposide 200 mg/m(2) daily on day 2-4. The CEV-regimen was five courses of epirubicin 50 mg/m(2), cyclophosphamide 1000 mg/m(2), and vincristine 2 mg, all IV on day 1. RESULTS: Patients administered second-line chemotherapy lived significantly longer with median survival 5.3 months compared to 2.2 months in patients with best supportive care only (P<0.001). The best supportive care patients had significantly worse PS status and more resistant disease. The crossover treatment group was well balanced regarding possible prognostic factors prior to initial treatment and at recurrence. No difference in survival was found (P=0.71). Univariate analysis revealed PS at recurrence, objective tumour response from initial chemotherapy, disease stage at first-line, LDH-, NSE-, and ALP at first-line to be significant prognostic factors for survival in the second-line setting. In a multivariate analysis, only PS at time of recurrence remained an independent prognostic factor (P<0.0001). CONCLUSION: Patients administered second-line chemotherapy had significantly longer survival than patients administered best supportive care. However, this difference can be explained by more negative prognostic factors in the best supportive care group. No survival difference between EP and CEV crossover chemotherapy was found. Multivariate analysis revealed PS at time of relapse as the only independent predictor of survival in the crossover recurrent SCLC group. SN - 0169-5002 UR - https://www.unboundmedicine.com/medline/citation/15829326/Second_line_chemotherapy_in_recurrent_small_cell_lung_cancer__Results_from_a_crossover_schedule_after_primary_treatment_with_cisplatin_and_etoposide__EP_regimen__or_cyclophosphamide_epirubicin_and_vincristin__CEV_regimen__ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0169-5002(04)00542-2 DB - PRIME DP - Unbound Medicine ER -