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Vol 78, No 3 (2010)
ORIGINAL PAPERS
Published online: 2010-05-11
Submitted: 2013-02-22
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The value of topotecan in the second-line treatment of small-cell lung cancer. Preliminary report

Beata Biernacka, Paweł Krawczyk, Jarosław Buczkowski, Anna Siwiec, Katarzyna Perżyło, Janusz Milanowski
Pneumonol Alergol Pol 2010;78(3):192-202.

open access

Vol 78, No 3 (2010)
ORIGINAL PAPERS
Published online: 2010-05-11
Submitted: 2013-02-22

Abstract


Introduction: Small cell lung cancer (SCLC) is an aggressive malignancy with high propensity for early regional and distant metastases. Response rate to first-line chemotherapy is high but typically short-therm. All patients with extensive disease and majority with limited disease have recurrence of disease. The choice of second-line chemotherapy in case of progression depends on many factors, including type of first-line chemotherapy, response to treatment, progression-free survival and patients’ performance status. No standard second-line treatment has been established until recently. Monotherapy with topotecan is widely used in second-line treatment especially in patients in poor performance status.
Material and methods: The aim of the study was to evaluate the results of monotherapy with topotecan. We also determined the predictive markers which could affect the therapeutic effect of topotecan. The examined group consisted of 42 patients with extensive stage of SCLC. Cox regression model was used to establish adverse factors, which were prognostic for overall survival of our patients divided into two groups according to administrated chemotherapy: 21 topotecan-treated and 21 standard chemotherapy-treated. Six variables that gave a maximum hazard ratio (HR) were used in the final model, e.g.: the age above 65 (HR = 2.35), anemia (HR = 1.83) and poor performance status (HR = 1.51). These variables scored the points according to their prognostic significance and HR.
Results: In Kaplan-Meier analysis, in the group of patients treated with topotecan, the higher survival probability was noted for patients scored below 10 points than for patients scored above 10 points. The prognostic scale was not useful for patients with other scheme of chemotherapy. Five partial responses (24%) in topotecan-treated patients were noted.
Conclusions: Precise qualification of patients to topotecan monotherapy in second-line treatment may be effective to prolong survival and increase the percentage of SCLC patients with objective response.

Abstract


Introduction: Small cell lung cancer (SCLC) is an aggressive malignancy with high propensity for early regional and distant metastases. Response rate to first-line chemotherapy is high but typically short-therm. All patients with extensive disease and majority with limited disease have recurrence of disease. The choice of second-line chemotherapy in case of progression depends on many factors, including type of first-line chemotherapy, response to treatment, progression-free survival and patients’ performance status. No standard second-line treatment has been established until recently. Monotherapy with topotecan is widely used in second-line treatment especially in patients in poor performance status.
Material and methods: The aim of the study was to evaluate the results of monotherapy with topotecan. We also determined the predictive markers which could affect the therapeutic effect of topotecan. The examined group consisted of 42 patients with extensive stage of SCLC. Cox regression model was used to establish adverse factors, which were prognostic for overall survival of our patients divided into two groups according to administrated chemotherapy: 21 topotecan-treated and 21 standard chemotherapy-treated. Six variables that gave a maximum hazard ratio (HR) were used in the final model, e.g.: the age above 65 (HR = 2.35), anemia (HR = 1.83) and poor performance status (HR = 1.51). These variables scored the points according to their prognostic significance and HR.
Results: In Kaplan-Meier analysis, in the group of patients treated with topotecan, the higher survival probability was noted for patients scored below 10 points than for patients scored above 10 points. The prognostic scale was not useful for patients with other scheme of chemotherapy. Five partial responses (24%) in topotecan-treated patients were noted.
Conclusions: Precise qualification of patients to topotecan monotherapy in second-line treatment may be effective to prolong survival and increase the percentage of SCLC patients with objective response.
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Keywords

small cell lung cancer; second-line chemotherapy; topotecan; overall survival

About this article
Title

The value of topotecan in the second-line treatment of small-cell lung cancer. Preliminary report

Journal

Advances in Respiratory Medicine

Issue

Vol 78, No 3 (2010)

Pages

192-202

Published online

2010-05-11

Bibliographic record

Pneumonol Alergol Pol 2010;78(3):192-202.

Keywords

small cell lung cancer
second-line chemotherapy
topotecan
overall survival

Authors

Beata Biernacka
Paweł Krawczyk
Jarosław Buczkowski
Anna Siwiec
Katarzyna Perżyło
Janusz Milanowski

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