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Irinotecan, topotecan, paclitaxel or docetaxel for second-line treatment of small cell lung cancer: a single-center retrospective study of efficiency comparation and prognosis analysis.

ABSTRACT: Background:The main aim of this study was to evaluate the efficiency of second-line chemotherapy irinotecan (CPT-11), topotecan (TPT), paclitaxel (PTX) and docetaxel (DTX) in small cell lung cancer (SCLC) patients who have failure to the first-line standard treatment. The secondary aim was to evaluate the independent prognostic factors of patients who received a second line treatment. Methods:Retrospective analysis of 116 patients who received second-line chemotherapy. Patients were divided into 4 groups according to the therapy they were treated with, which were CPT-11, TPT, PTX and DTX. Progress free survival (PFS), overall survival (OS), objective response rate (ORR) and disease control rate (DCR) were evaluated for each group. Patients' data of clinical character and blood index were collected, and the prognostic factors were assessed both at univariate and multivariate levels. Results:Patients treated with CPT-11 achieved the best median PFS and OS of 91 and 595 days, while the median PFS of TPT, PTX and DTX were 74.5, 81 and 50 days respectively. The median OS of them were 154, 168.5 and 184 days respectively. The survival curves of OS were significantly different (P=0.0069). The reaction to second-line therapy is positively correlate to the reaction to first-line therapy (P=0.012). In the multivariate analysis, treatment free interval (TFI) <90 days, lactate dehydrogenase (LDH) ?225 U/L, neutrophil-to-lymphocyte ratio (NLR) ?3.5 were identified as independent risk factors for poor prognosis in second-line SCLC patients. Conclusions:Second-line chemotherapy with TPT in SCLC patients may provide better overall survival benefits. TFI <90 days, LDH ?225 U/L and NLR ?3.5 are independent risk factors for second-line SCLC patients.

SUBMITTER: Zhao Y

PROVIDER: S-EPMC6976368 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Irinotecan, topotecan, paclitaxel or docetaxel for second-line treatment of small cell lung cancer: a single-center retrospective study of efficiency comparation and prognosis analysis.

Zhao Yuan Y Wan Bing B Zhang Tianli T Xu Yangyang Y Liu Hongbing H Lv Tangfeng T Zhang Fang F Zhan Ping P Song Yong Y

Translational lung cancer research 20191201 6

<h4>Background</h4>The main aim of this study was to evaluate the efficiency of second-line chemotherapy irinotecan (CPT-11), topotecan (TPT), paclitaxel (PTX) and docetaxel (DTX) in small cell lung cancer (SCLC) patients who have failure to the first-line standard treatment. The secondary aim was to evaluate the independent prognostic factors of patients who received a second line treatment.<h4>Methods</h4>Retrospective analysis of 116 patients who received second-line chemotherapy. Patients we ...[more]

PMID: 32010561

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Project description:Purpose: Treatment of advanced pancreatic cancer with a single therapeutic at a maximal dose has been largely ineffective at increasing survival. Combination therapies are commonly studied but often limited by toxicity. We previously showed that low-dose multiagent therapy with gemcitabine, docetaxel (taxotere), capecitabine (xeloda), and cisplatin (GTX-C) was safe, well tolerated, and effective (NCT01459614). Here, we hypothesize that adding irinotecan to GTX-C may improve survival with minimal toxicity. Experimental Design: Patients with treatment-naïve metastatic pancreatic adenocarcinoma were treated with gemcitabine, docetaxel (taxotere), capecitabine (xeloda), cisplatin, and irinotecan (GTX-CI). Treatment consisted of capecitabine 500 mg twice daily on days 1–14 and gemcitabine 300 to 500 mg/m2, docetaxel 20 mg/m2, cisplatin 15 to 20 mg/m2, and irinotecan 20 to 60 mg/m2 on days 4 and 11 of a 21-day cycle. The primary objective was 9-month overall survival (OS). Secondary objectives included response rate (RR), disease control rate (DCR), progression-free survival (PFS), and OS. Results: The regimen was well tolerated. The recommended phase II dose was gemcitabine 500 mg/m2, docetaxel 20 mg/m2, capecitabine 500 mg po bid, cisplatin 20 mg/m2, and irinotecan 20 mg/m2. Median follow-up in phase II was 11.02 months (2.37–45.17). Nine-month OS rate was 57% [95% confidence interval (CI): (41–77)]. RR was 57% [95% CI: (37–75) 50% PR and 7% CR]. DCR was 87% [95% CI: (69–96)]. Median OS and PFS were 11.02 [95% CI: (8.54–21.09)] and 8.34 [95% CI: (6.34–NA)] months, respectively. Conclusions: The addition of irinotecan to GTX-C was safe and well tolerated. While the study did not meet its primary objective, the responses were clinically meaningful using a well-tolerated regimen. Significance: We aimed to optimize the previously reported efficacious regimen of low-dose multiagent therapy with GTX-C for the treatment of metastatic pancreatic ductal adenocarcinoma by adding irinotecan. The primary objective was not met, but GTX-CI was well tolerated. The RR of 57%, median PFS of 8.3 months, median OS of 11 months, and 36-month OS rate of 19% suggest clinical benefit. Further optimization of this regimen is warranted.

Project description:BackgroundApatinib is an oral small-molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor 2 (VEGFR-2). Some clinical trials have demonstrated that apatinib is efficacious against advanced nonsquamous NSCLC.ObjectiveThis study aimed to probe efficacy and safety of apatinib plus docetaxel, as the second or above line treatment, in advanced nonsquamous NSCLC.DesignMulticenter, prospective, single arm study.SettingThree teaching hospitals centers in the Sichuan.ParticipantsFourteen patients with stage IVA/B nonsquamous NSCLC had previously received at least 1 platinum-based chemotherapy regimen.InterventionPatients who were enrolled between November 2016 and January 2018 were given docetaxel (75 mg/m, i.v., d1) plus oral apatinib (250 mg/d), 4 weeks as one cycle, until disease progression or intolerance to adverse events (AE).Main outcome measuresThe primary endpoint was progression-free survival (PFS). The secondary endpoints comprised objective response rate (ORR), disease control rate (DCR), overall survival (OS), and AE incidence rate.ResultsAll patients carried adenocarcinoma by pathological type. The median follow-up duration was 9.76 months. Out of 14 cases, 12 were evaluable, showing ORR of 33.33%, DCR of 66.67%, DCR of 50% in cases with brain metastasis, median PFS of 2.92 months (95% CI: 1.38-4.48), and 6-month OS of 80%. Primary AEs encompassed: leukopenia in 7 cases (58.33%), hand-foot skin reaction in 5 cases (41.67%), and diarrhea in 4 cases (33.33%). Among them, grade 3 AEs were: leukopenia in 4 cases (33.33%), and hand-foot skin reaction in 1 case (8.33%). No grade 4/5 AEs were reported. Univariate and multivariate analysis were conducted respectively for PFS and OS. These factors encompassed: gender, age, gene mutations, clinical stage, ECOG scores, quantity of metastatic foci, brain metastasis, and hand-foot skin reaction. Results demonstrated zero risk factors for PFS or OS.ConclusionApatinib plus docetaxel, as the second or above line treatment, is effective and safe against advanced nonsquamous NSCLC, with good tolerance profile.Trial registrationNCT03416231.

Dataset Information

Irinotecan, topotecan, paclitaxel or docetaxel for second-line treatment of small cell lung cancer: a single-center retrospective study of efficiency comparation and prognosis analysis.

Publications

Irinotecan, topotecan, paclitaxel or docetaxel for second-line treatment of small cell lung cancer: a single-center retrospective study of efficiency comparation and prognosis analysis.

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