Etoposide plus cisplatin followed by concurrent chemo-radiotherapy and irinotecan plus cisplatin for patients with limited-stage small cell lung cancer: A multicenter phase II study

Abstract

Purpose The combination of irinotecan and cisplatin (IP) has shown at least comparable efficacy to that of etoposide/cisplatin (EP) in patients with extensive-stage small cell lung cancer. We conducted a phase II study to evaluate the efficacy and tolerance of EP regimen followed by thoracic radiotherapy (TRT) and IP consolidation chemotherapy in patients with limited-stage small cell lung cancer. Patients and methods Thirty-three chemotherapy-naive patients with limited-stage small cell lung cancer (LS-SCLC) were treated with etoposide 100 mg/m 2 on days 1–3 and cisplatin 80 mg/m 2 on day 1. Radiotherapy was given 3 weeks after the first treatment cycle concurrently with weekly cisplatin 20 mg/m 2 on day 1 and etoposide 50 mg/m 2 on day 4 within 5–6 weeks, followed by three courses of irinotecan 60 mg/m 2 on days 1, 8, and 15 and cisplatin 60 mg/m 2 on day 1 of a 4-week cycle. Results There were no treatment-related deaths. Toxicities during chemo-radiotherapy were mild including grade 3/4 neutropenia (24%) and grade 2 esophagitis (6%). The major toxicity observed during consolidation chemotherapy was grades 3–4 neutropenia which affected 42% of patients. In an intention-to-treat analysis the overall response rate was 66% (CR: 30% and PR: 36%). After a median follow-up period of 35.7 months (range: 9.6–41.2 months), the median survival time was 19 months (95% CI: 14.5–23.5 months), the median time to tumor progression 8.3 months and the 1- and 2-year survival rates 72% and 27.5%, respectively. Conclusions Consolidation chemotherapy with IP following concurrent EP plus TRT is a safe and with acceptable toxicity regimen and deserves further phase III testing in patients with LS-SCLC.