Efficacy analysis and multi-factor retrospective study of third-line chemotherapy in 82 Chinese patients with small cell lung cancer ⁎

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Abstract Objective As there is currently no clear recommendation for third-line chemotherapy for small cell lung cancer (SCLC), its efficacy is unknown. To date, there have rarely been reports of Chinese patients with SCLC who received third-line chemotherapy. Therefore, we investigated the efficacy, safety, and prognostic factors of Chinese patients with SCLC treated with third-line chemotherapy. Methods A retrospective analysis of patients with SCLC who received third-line chemotherapy was performed. Results Between 2007 and 2013, 82 patients [62 men (75.6%), 20 women (24.4%); median age at the time of diagnosis, 55 years] received third-line chemotherapy at our center. Of these patients, 44 had limited-stage disease and 38 had extensive-stage disease. On third-line chemotherapy, 55 (67.1%) patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, objective response rate of 15.9%, and median overall survival after third-line chemotherapy (OS-3) and median progression-free survival after third-line chemotherapy (PFS-3) of 5.6 months and 3.0 months, respectively. On univariate analysis, PFS-3 was significantly related with ECOG PS (P = 0.005), response to second-line chemotherapy (P = 0.002), response to third-line chemotherapy (P < 0.001), and PFS after second-line chemotherapy (P = 0.026). OS-3 was significantly related with ECOG PS (P < 0.001), response to thirdline chemotherapy (P = 0.033), PFS after first-line therapy (P = 0.044), and PFS after second-line therapy (PFS-2) (P = 0.007). On multivariate analysis, ECOG PS (P = 0.008) and response to third-line chemotherapy (P = 0.046) were independent prognostic factors for PFS-3, while ECOG PS (P = 0.007) and PFS-2 (P < 0.001) were independent prognostic factors for OS-3. Conclusion Few patients with SCLC receive third-line chemotherapy. Our findings suggest that patients with an ECOG PS 0-1 and PFS-2 for >3 months will be benefit from third-line chemotherapy, which should be actively offered to them.