Limited-stage, small-cell lung cancer (SCLC) treated with concurrent irinotecan-platinum.

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e17517 Background: Irinotecan and cisplatin with concurrent radiation is an effective and tolerable regimen in limited-stage SCLC is frequently used by our Asian colleagues but infrequently by North American thoracic oncologists. (Han et al J Clin Onc 2005; 23:3488-3494 and Jeong et al Lung Cancer 2006; 53:361-366). We describe our institutional multidisciplinary thoracic oncology program experience in a group of patients with limited-stage SCLC treated with irinotecan plus platinum and concurrent thoracic irradiation. Methods: Between May 2006 and December 2009, 17 patients were identified through our database with limited-stage SCLC receiving definitive treatment with 65 mg/m2 irinotecan on days 1 and 8 and with 30 mg/m2 cisplatin on day 1 every 22 days for planned 4 cycles; three patients received carboplatin in substitution for cisplatin. Concurrent thoracic radiotherapy started with cycle 2; eight patients received 150 cGy twice-daily radiation in 30 fractions (45Gy) and five patients received once daily radiation in 30 fractions (54 Gy). Eight patients underwent prophylactic cranial irradiation. Nine patients were males (53%), and 14 patients (82%) had a performance status of 0/1. Median age 67 years and 4 patients (23%) were older than 70 years. Results: The objective response rate was 70% after concurrent chemoradiotherapy (10 CR; 2 PR). 9/17 patients are still alive at a median follow-up of 12 months. 53% are alive past the 1-year mark and 18% alive past the 2-year mark. Grade 3 neutropenia developed in 29% of patients with only one episode of febrile neutropenia, esophagitis in 18% of patients, and there were no symptomatic instances of pneumonitis. Conclusions: Irinotecan and platinum with concurrent once or twice-daily thoracic RT is a well tolerated and effective definitive treatment approach for limited-stage SCLC. Specifically, no cases of radiation pneumonitis were observed in this series of patients. No significant financial relationships to disclose.