524P - A study in recurrent small cell lung cancer patients, comparing weekly paclitaxel, irinotecan and temozolomide in second-line: A prospective study from a south Indian tertiary cancer hospital

Abstract

BackgroundRecurrence is a rule after 1st line therapy in small cell lung cancer (SCLC). Patients who would not tolerate platinum or who recur within 6 months of 1st line therapy; choice of 2nd line is not well defined in them. MethodsSCLC patients, who progressed within 6 months after 1st line, or at anytime but who are not candidates for platinum, were non-randomly assigned to receive Paclitaxel 80mg/m2 weekly or Irinotecan 100mg/m2 weekly, till progression or for 12 cycles, or Temozolomide 75mg/m2 21days, every 4 weekly for 6 cycles in patients with brain metastasis. Response, toxicities, survival durations were noted. ResultsIn Irinotecan arm 1(12.5%) had PR, 2(25%) had SD and 3(37.5%) had PD (Response rate[RR]=37.5%). In the Taxane arm, 2(9.5%) had CR, 8(38.0%) had PR, 5(23.8%) had SD, and 6(28.5%) had PD (RR = 71.4%). 2(33.3%) had PR, 1(16.6%) had SD (RR = 50%) in the Temozolomade arm. Mean and median PFS after 2nd line after a min follow up of 18 months was 2.27 and 1.5 months for the whole cohort. Same for Taxane, Irinotecan and Temozolomide were (3.04 and 3 months), (0.81 and 0 months) and (1.5 and 0 months) respectively (p = 0.035). HR for progression for Taxane and Irinotecan were (0.565 p = 0.24, 95% CI [0.218-1.464]) and (1.358 p = 0.575, 95% CI [0.466-3.957]) respectively. Avg grade ¾ haematologic toxicities, febrile neutropenia, GI and hepatotoxicities were lowest for Taxane (0.81/patient p = 0.001, 0.48/patient p = 0.047, 1.14/patient p = 0.137 and 0.19/patient p = 0.08 respectively). Hypersensitivity (all grades) were more common for Irinotecan than taxane (0.62 vs 0.33/patient, p = 0.196). 3 patients died of causes attributed to therapy (2 out of 8 [25%] of Irinotecan arm, 1 out of 21 [4.7%] of Taxane arm). Median OS for the whole cohort was 11.5 months; highest for Taxane 12.5 months> 11 months for Temozolomide>9.5 months for Irinotecan, p = 0.185. HR for death for Taxane and Irinotecan were (0.643 p = 0.376, 95% CI [0.242-1.710]) and (1.383 p = 0.550, 95% CI [0.477-4.009]) respectively. ConclusionsWeekly Paclitaxel in 2nd line may have favourable toxicity profile and response rate comparable to Irinotecan or Temozolomide; may translate into better quality of life and OS. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.