Abstract
PurposeAmrubicin is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). Previous studies reported its effectiveness and severe hematological toxicity. However, the efficacy of amrubicin monotherapy in elderly patients with SCLC has not been described. The objective of this study was to investigate the feasibility of amrubicin monotherapy in elderly patients and its efficacy for relapsed SCLC.MethodsA retrospective cohort study design was used. We retrospectively evaluated the clinical effects and adverse events of amrubicin treatment in elderly (≥70 years) SCLC patients with relapsed SCLC.ResultsBetween November 2003 and September 2015, 86 patients (aged ≥70 years) received amrubicin monotherapy for relapsed SCLC at four institutions. There were 42 cases of sensitive relapse (S) and 44 of refractory relapse (R). S cases with median age of 75 years (range 70–85 years) and R cases with median age of 74 years (range 70–84 years) were included in our analysis. The median number of treatment cycles was three (range 1–9), and the response rate was 33.7% (40.5% in the S and 27.2% in the R cases). Median progression-free survival time was 4.0 months in the S and 2.7 months in the R patients (p = 0.013). Median survival time from the start of amrubicin therapy was 7.6 months in the S and 5.5 months in the R cases (p = 0.26). The frequencies of grade ≥3 hematological toxicities were as follows: leukopenia, 60.4%; neutropenia, 74.4%; anemia, 11.6%; thrombocytopenia, 16.2%; and febrile neutropenia, 17.4%. Treatment-related death was observed in one patient.ConclusionAlthough hematological toxicities, particularly neutropenia, were severe, amrubicin showed favorable efficacy, not only in the S but also in the R cases, as shown in previous studies. Amrubicin could be a preferable standard treatment in elderly patients with relapsed SCLC. These results warrant further evaluation of amrubicin in elderly patients with relapsed SCLC by a prospective trial.
Highlights
Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancer cases and is characterized by an aggressive nature and rapid growth [1]
Patients who responded to initial chemotherapy and relapsed >3 months after chemotherapy were defined as sensitive relapse (S) patients, while patients who did not respond to initial chemotherapy or relapsed within 3 months were defined as refractory relapse (R) patients
Febrile neutropenia occurred in 14.5% of patients when the dose was 35 mg/m2 per day or less and in 33.3% of patients when the dose was 40 mg/m2 per day or more. This retrospective study assessed the effect and safety of amrubicin monotherapy for the treatment of recurrent or refractory SCLC, in patients who had previously been treated with a platinum-based regimen
Summary
Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancer cases and is characterized by an aggressive nature and rapid growth [1]. Advanced age is associated with an increased risk of lung cancer. The increase in global life expectancy has resulted in a corresponding increase in the incidence of lung cancer. The elderly population has been disproportionately affected, with considerable increases in the disease incidence in this age group. The Japan Clinical Oncology Group (JCOG) recommended that carboplatin plus etoposide was an active and less toxic regimen in elderly patients with SCLC [4]. There are, at present, no recommended chemotherapy agents or regimens for relapsed SCLC in elderly patients. Further complicating the treatment of these patients is their tendency to poorly tolerate chemotherapy and the requirement of clinical management based on individual parameters such as performance status, extent of metastatic disease, quality of life and laboratory data [5,6,7]. Whether standard chemotherapy in elderly patients is always safe for use in clinical practice is unclear [8]
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