Chemotherapy Versus Best Supportive Care for Extensive Small Cell Lung Cancer

Summary

A Cochrane review[Abstract]1 included 2 studies with a total of 88 patients for first-line chemotherapy (men under 70 years with good performance status) and 3 studies with a total of 932 patients for second-line chemotherapy at relapse (men and women under 75 years and any performance status). First-line chemotherapy: Ifosfamide gave an extra mean survival of 78.5 days compared with supportive care or placebo infusion. Partial tumour response was greater with the active treatment. Toxicity was only seen in the chemotherapy group. Second-line chemotherapy: Compared to the symptomatic treatment group, methotrexate-doxorubicin treatment gave a median survival of 63 days longer (P < 0.001) for patients allocated to receive four cycles of first-line chemotherapy, and 21 days longer (P = 0.160) for patients allocated to receive eight cycles of first-line chemotherapy. Treatment with topotecan gave a median survival of 84 days longer than in the best supportive care (BSC) group (log-rank P = 0.01). The adjusted hazard ratio for overall survival was 0.61 (95% CI 0.43 to 0.87). Treatment with picoplatin gave a median survival time of 6 days longer than BSC (HR 0.817, 95% CI 0.65 to 1.03). A meta-analysis of topotecan and picoplatin gave a HR of 0.73 (95% CI 0.55 to 0.96). Toxicity was worst in the chemotherapy group. Quality of life was better in the topotecan group and was not measured in the methotrexate-doxorubicin and picoplatin studies.

Comment:The studies of first-line chemotherapy were carried out more than 30 years ago. Platinum-based combination chemotherapy regimens have been shown to increase complete response rates when compared to non-platinum chemotherapy regimens with no significant difference in survival, and so these are currently the standard first-line treatment for patients with small cell lung cancer.