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André L, Antherieu G, Boinet A, Bret J, Gilbert T, Boulahssass R, Falandry C. Oncological Treatment-Related Fatigue in Oncogeriatrics: A Scoping Review. Cancers (Basel) 2022; 14:cancers14102470. [PMID: 35626074 PMCID: PMC9139887 DOI: 10.3390/cancers14102470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Fatigue in older patients has multiple etiologies, as this symptom may be cancer-related, treatment-related, age-related, or part of frailty syndrome. Physicians need to identify this symptom and understand its risk factors but also evaluate the risk/benefit ratio of cancer treatments considering the risk of impairing the patient’s quality of life. This scoping review was aimed to present the level of information currently available on any-grade fatigue and grade 3 or more fatigue for each cancer treatment regimen, either in general or in older populations, for the most prevalent tumors. Abstract Fatigue is a highly prevalent symptom in both cancer patients and the older population, and it contributes to quality-of-life impairment. Cancer treatment-related fatigue should thus be included in the risk/benefit assessment when introducing any treatment, but tools are lacking to a priori estimate such risk. This scoping review was designed to report the current evidence regarding the frequency of fatigue for the different treatment regimens proposed for the main cancer indications, with a specific focus on age-specific data, for the following tumors: breast, ovary, prostate, urothelium, colon, lung and lymphoma. Fatigue was most frequently reported using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) versions 3 to 5. A total of 324 regimens were analyzed; data on fatigue were available for 217 (67%) of them, and data specific to older patients were available for 35 (11%) of them; recent pivotal trials have generally reported more fatigue grades than older studies, illustrating increasing concern over time. This scoping review presents an easy-to-understand summary that is expected to provide helpful information for shared decisions with patients regarding the anticipation and prevention of fatigue during each cancer treatment.
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Affiliation(s)
- Louise André
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Gabriel Antherieu
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Amélie Boinet
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Judith Bret
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
| | - Thomas Gilbert
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- Research on Healthcare Professionals and Performance RESHAPE, Inserm U1290, Lyon 1 University, 69008 Lyon, France
| | - Rabia Boulahssass
- Geriatric Coordination Unit for Geriatric Oncology (UCOG) PACA Est CHU de Nice, 06000 Nice, France;
- FHU OncoAge, 06000 Nice, France
- Faculty of Medicine, University of Nice Sofia Antilpolis, 06000 Nice, France
| | - Claire Falandry
- Hospices Civils de Lyon, Geriatrics Department, Hôpital Lyon Sud, 69230 Saint Genis-Laval, France; (L.A.); (G.A.); (A.B.); (J.B.); (T.G.)
- FHU OncoAge, 06000 Nice, France
- CarMeN Laboratory, INSERM U.1060/Université Lyon1/INRA U. 1397/INSA Lyon/Hospices Civils Lyon, Bâtiment CENS-ELI 2D, Hôpital Lyon Sud Secteur 2, 69310 Pierre-Bénite, France
- UCOGIR—Auvergne-Rhône-Alpes Ouest–Guyane, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
- Faculty of Medicine and Maieutics Charles Mérieux, Lyon 1 University, 69310 Pierre-Bénite, France
- Correspondence: ; Tel.: +33-478-863-287
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Horinouchi H, Ohe Y. History of Japan Clinical Oncology Group (JCOG) Lung Cancer Study Group. Jpn J Clin Oncol 2020; 50:502-511. [PMID: 32115625 DOI: 10.1093/jjco/hyaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/05/2020] [Indexed: 11/15/2022] Open
Abstract
The Japan Clinical Oncology Group Lung Cancer Study Group has been carrying out clinical studies, exploring new strategies of treatment, supportive therapies (antiemetics, etc.), etc., for a variety of cancers, including not only small cell lung cancer and non-small cell lung cancer but also rare chest tumours (represented by thymoma) and cancer-associated conditions (cancerous pericarditis, cancerous pleuritis, etc.). In this review, an overview of all studies conducted from 1985 to 2019 is provided.
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Affiliation(s)
- Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Sun A, Durocher-Allen LD, Ellis PM, Ung YC, Goffin JR, Ramchandar K, Darling G. Initial management of small-cell lung cancer (limited- and extensive-stage) and the role of thoracic radiotherapy and first-line chemotherapy: a systematic review. Curr Oncol 2019; 26:e372-e384. [PMID: 31285682 PMCID: PMC6588077 DOI: 10.3747/co.26.4481] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Patients with limited-stage (ls) or extensive-stage (es) small-cell lung cancer (sclc) are commonly given platinum-based chemotherapy as first-line treatment. Standard chemotherapy for patients with ls sclc includes a platinum agent such as cisplatin combined with the non-platinum agent etoposide. The objective of the present systematic review was to investigate the efficacy of adding radiotherapy to chemotherapy in patients with es sclc and to determine the appropriate timing, dose, and schedule of chemotherapy or radiation for patients with sclc. Methods The medline and embase databases were searched for randomized controlled trials (rcts) comparing treatment with radiotherapy plus chemotherapy against treatment with chemotherapy alone in patients with es sclc. Identified rcts were also included if they compared various timings, doses, and schedules of treatment for patients with es sclc or ls sclc. Results Sixty-four rcts were included. In patients with ls sclc, overall survival was greatest with platinum-etoposide compared with other chemotherapy regimens. In patients with es sclc, overall survival was greatest with chemotherapy containing platinum-irinotecan than with chemotherapy containing platinum-etoposide (hazard ratio: 0.84; 95% confidence interval: 0.74 to 0.95; p = 0.006). The addition of radiation to chemotherapy for patients with es sclc showed mixed results. There was no conclusive evidence that the timing, dose, or schedule of thoracic radiation affected treatment outcomes in sclc. Conclusions In patients with ls sclc, cisplatin-etoposide plus radiotherapy should remain the standard therapy. In patients with es sclc, the evidence is insufficient to recommend the addition of radiotherapy to chemotherapy as standard practice to improve overall survival. However, on a case-by-case basis, radiotherapy might be added to reduce local recurrence. The most commonly used chemotherapy is platinum-etoposide; however, platinum-irinotecan can be considered.
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Affiliation(s)
- A Sun
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | | | - P M Ellis
- Medical Oncology, Juravinski Cancer Centre, Hamilton, ON
- Department of Oncology, McMaster University, Hamilton, ON
| | - Y C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON
| | - J R Goffin
- Medical Oncology, Juravinski Cancer Centre, Hamilton, ON
| | - K Ramchandar
- Radiation Oncology, Thunder Bay Regional Health Sciences Centre Regional Cancer Care, Thunder Bay, ON
| | - G Darling
- Thoracic Surgery, Toronto General Hospital, Toronto, ON
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Sun A, Durocher-Allen LD, Ellis PM, Ung YC, Goffin JR, Ramchandar K, Darling G. Guideline for the Initial Management of Small Cell Lung Cancer (Limited and Extensive Stage) and the Role of Thoracic Radiotherapy and First-line Chemotherapy. Clin Oncol (R Coll Radiol) 2018; 30:658-666. [PMID: 30007803 DOI: 10.1016/j.clon.2018.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022]
Abstract
AIMS We investigated the efficacy of adding radiotherapy to chemotherapy in patients with extensive stage small cell lung cancer (ES-SCLC) and the appropriate timing, dose and schedule of treatment for patients with ES-SCLC or limited stage SCLC (LS-SCLC). MATERIALS AND METHODS The guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care and by the Lung Cancer Disease Site Group through a systematic review of randomised controlled trials. KEY RECOMMENDATIONS In patients with LS-SCLC (stage I, II and III), the addition of thoracic radiotherapy to standard chemotherapy is recommended. However, there is no clear evidence to inform definitive recommendations for optimal timing, sequential versus concurrent therapies and optimal dose or regimen. In patients with LS-SCLC, etoposide-cisplatin is the preferred regimen for adults who are being treated with combined modality therapy with curative intent. In patients with ES-SCLC (stage IV), there is insufficient evidence to recommend the addition of thoracic radiotherapy to standard chemotherapy as a standard practice for survival benefit; however, it could be considered on a case-by-case basis to reduce local recurrence. In patients with ES-SCLC, a platinum agent plus etoposide is the preferred regimen for adult patients who are being treated with combined modality therapy. Cisplatin and irinotecan represents an alternative treatment option to this, but is associated with increased rates of adverse events such as diarrhoea.
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Affiliation(s)
- A Sun
- Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - L D Durocher-Allen
- Program in Evidence-Based Care, McMaster University, Hamilton, Ontario, Canada
| | - P M Ellis
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada; Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Y C Ung
- Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - J R Goffin
- Medical Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - K Ramchandar
- Radiation Oncology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - G Darling
- Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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Triplet combination of carboplatin, irinotecan, and etoposide in the first-line treatment of extensive small-cell lung cancer: a single-institution phase II study. Anticancer Drugs 2010; 21:651-5. [DOI: 10.1097/cad.0b013e3283393718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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William WN, Uyeki J, Johnson FM, Feng L, Peeples BO, Fossella FV, Karp DD, Blumenschein GR, Stewart DJ, Glisson BS. Weekly alternating therapy with irinotecan plus cisplatin and etoposide plus cisplatin in the treatment of patients with extensive small cell lung carcinoma. Cancer 2010; 116:2409-15. [PMID: 20225329 DOI: 10.1002/cncr.25076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Irinotecan has significant activity in small-cell lung cancer (SCLC). The authors' previous phase 1 study of alternating weekly therapy with irinotecan/cisplatin (IP), etoposide/cisplatin (EP), and granulocyte-colony-stimulating factor (G-CSF) support was well tolerated and active in patients with SCLC. A phase 2 trial was conducted to estimate the efficacy of this regimen in previously untreated patients with extensive SCLC. METHODS A total of 33 patients were treated between June 2002 and July 2007. Patients received 12 weeks of therapy with cisplatin (20 mg/m(2)) on Day 1 and irinotecan (100 mg/m(2)) on Day 1 and G-CSF on Days 2 to 5 (Weeks 1, 3, 5, 7, 9, and 11) followed by cisplatin (20 mg/m(2)) on Day 1 and etoposide (60 mg/m(2)) on Days 1 to 3 with G-CSF on Days 4 to 7 (Weeks 2, 4, 6, 8, 10, and 12). The primary endpoint was 1-year survival rate. RESULTS Grade 4 neutropenia (toxicities were determined using the National Cancer Institute Common Toxicity Criteria [version 2.0]) was noted in 5 (1.5%) of 343 courses with neutropenic fever in only 5 (1%) of 343 courses. One patient died of neutropenic sepsis. Nonhematologic toxicities grade >or=2 were observed in 15 (4%) of 343 courses and were limited to fatigue, hyponatremia, and diarrhea. The overall objective response rate was 89% in 28 assessable patients (no complete responses and 25 partial responses). The median progression-free and overall survivals were 6.0 months and 10.9 months, respectively. The 1-year survival rate was 33%. CONCLUSIONS Weekly therapy with IP alternating with EP and G-CSF support was well tolerated in patients with extensive SCLC, but did not demonstrate improved progression-free or overall survival when compared with historical controls at the study institution.
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Affiliation(s)
- William N William
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Integration of irinotecan and cisplatin with early concurrent conventional radiotherapy for limited-disease SCLC (LD-SCLC). Int J Clin Oncol 2009; 14:230-6. [PMID: 19593615 DOI: 10.1007/s10147-008-0842-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 09/27/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study was conducted using irinotecan and cisplatin (IP) concurrently with thoracic radiation therapy to evaluate the response and toxicity of this protocol in the treatment of patients with limited-disease small cell lung cancer (LD-SCLC). METHODS Twenty-seven chemotherapy-naive patients with LD-SCLC received two cycles of weekly irinotecan 60 mg/m(2) and cisplatin 60 mg/m(2) before the initiation of the thoracic radiation therapy. RESULTS Of the 29 patients with LD-SCLC enrolled in the study, 27 were eligible for evaluation of response and toxicity. The median age was 62 years; 26 patients (90%) were men. Eastern Cooperative Oncology Group (ECOG) performance status was 0 in 5 patients (17%) and 1 in 18 patients (62%). Ten patients (37%) achieved a complete response (CR), 14 patients (52%) achieved a partial response (PR), while 3 patients (11%) had progressive disease (PD); one of the 3 nonresponders achieved a PR after commencing concurrent chemoradiotherapy; therefore, the overall response rate was 93%. The median survival time was 20.2 months and 1- and 2-year survival rates were 69% and 53.2%, respectively. The median progression-free survival (PFS) was 11.8 months, and 1- and 2-year PFS times were 52% and 34.1%, respectively. Neutropenia was the most prevalent hematological toxicity and it was evident as grade 3 in 14 patients (52%). Asthenia was the most prevalent nonhematological toxicity, in 18 patients (67%); esophagitis occurred in 15 patients (56%). No treatment-related deaths (due to sepsis or bleeding) were reported in the study. CONCLUSION Irinotecan and cisplatin is considered to be an effective and safe chemotherapeutic regimen when used concurrently with thoracic radiation therapy for the treatment of patients with LD-SCLC.
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Nowara E, Suwinski R. Time Factor in Radiotherapy and Chemotherapy for Limited Disease Small-Cell Lung Cancer. Cancer Invest 2009; 25:163-71. [PMID: 17530486 DOI: 10.1080/07357900701209020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prognostic significance of planned and unplanned gaps in radiotherapy and chemotherapy for limited-disease small-cell lung cancer (LD-SCLC) has been retrospectively evaluated in a series of 245 patients. All of them had cisplatine-based chemotherapy and fractionated radiotherapy. There was substantial heterogeneity in overall radiation treatment time and dose-intensity of chemotherapy attributable mostly to planned and unplanned gaps in therapy. Several variables that potentially may influence survival of the patients after treatment, including duration of treatment gaps, and dose-intensity of chemotherapy and radiotherapy were analyzed using univariate and multivariate Cox regression model. The following variables had significant and independent negative influence on survival in a multivariate model: performance status ZUBROD > 0 (p < 0.0001), metastases to supraclavicular nodes (p = 0.001), dyspnoea according to Borg scale > 2 (p = 0.004) and the average dose intensity of radiotherapy < 80 percent (p = 0.02). An independent association between total dose and survival also has been found. The dose-intensity of chemotherapy did not appear to significantly influence survival. While due to the retrospective character of the present research, this conclusion must be regarded as hypothesis-generating only, we assume that within the range of doses and dose-intensitites used in the present group the preventable gaps in radiotherapy and undue reduction of total radiation dose should be promptly avoided, while gaps in chemotherapy can be deemed acceptable if crucially demanded by the tolerance of treatment.
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Affiliation(s)
- Elzbieta Nowara
- Department of Medical Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Branch Gliwice, Poland
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Lee JE, Park HS, Jung SS, Kim JO, Kim SY. Phase II study of a 3-week schedule of irinotecan combined with cisplatin in previously untreated extensive-stage small-cell lung cancer. Oncology 2008; 73:76-80. [PMID: 18334853 DOI: 10.1159/000120632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 09/12/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Irinotecan has been introduced to improve the treatment of small-cell lung cancer (SCLC). We conducted a trial involving a 3-week schedule of irinotecan combined with cisplatin (IP) to validate the efficacy and toxicity of this regimen in patients with previously untreated extensive-stage SCLC (ES-SCLC). PATIENTS AND METHODS Twenty-eight patients with previously untreated ES-SCLC were enrolled in the study between January 2003 and December 2005. Irinotecan 60 mg/m(2) was administered intravenously on days 1 and 8 in combination with cisplatin 60 mg/m(2) on day 1 every 21 days. RESULTS Twenty-eight patients were followed until July 2007. The median follow-up time was 15.6 months. The actual dose intensities (DIs) of cisplatin and irinotecan were 97.7 and 92.2%, respectively. Among the 28 ES-SCLC patients, the objective response rate was 89.3% (25 patients). The major grade 3/4 hematological toxicity was neutropenia (26.9% of cycles). Grade 3/4 non-hematological toxicities were rare. The median progression-free and overall survival times were 8.7 and 16.5 months, with a 1-year survival rate of 66.6% and 2-year survival rate of 22.2%. CONCLUSION The 3-week schedule of IP was feasible and showed a high DI of irinotecan and decreased toxicity.
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Affiliation(s)
- Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital and Cancer Research Institute, Daejeon, South Korea
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Sekine I, Nokihara H, Takeda K, Nishiwaki Y, Nakagawa K, Isobe H, Mori K, Matsui K, Saijo N, Tamura T. Randomised phase II trial of irinotecan plus cisplatin vs irinotecan, cisplatin plus etoposide repeated every 3 weeks in patients with extensive-disease small-cell lung cancer. Br J Cancer 2008; 98:693-6. [PMID: 18253118 PMCID: PMC2259188 DOI: 10.1038/sj.bjc.6604233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patients with previously untreated extensive-disease small-cell lung cancer were treated with irinotecan 60 mg m(-2) on days 1 and 8 and cisplatin 60 mg m(-2) on day 1 with (n=55) or without (n=54) etoposide 50 mg m(-2) on days 1-3 with granulocyte colony-stimulating factor support repeated every 3 weeks for four cycles. The triplet regimen was too toxic to be considered for further studies.
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Affiliation(s)
- I Sekine
- Division of Internal Medicine and Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan.
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Pectasides D, Samantas E, Fountzilas G, Briasoulis E, Kosmidis P, Skarlos D, Dimopoulos MA, Kalofonos HP, Economopoulos T, Syrigos K. Combination chemotherapy with cisplatin, etoposide and irinotecan in patients with extensive small-cell lung cancer: A phase II study of the Hellenic Co-operative Oncology Group. Lung Cancer 2007; 58:355-61. [PMID: 17698241 DOI: 10.1016/j.lungcan.2007.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 06/21/2007] [Accepted: 06/27/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy and toxicity of cisplatin, etoposide and irinotecan as first-line treatment in patients with extensive small-cell lung cancer (E-SCLC). PATIENTS AND METHODS Chemo-naïve adult patients with a performance status (PS) of 0-2 and adequate organ function were eligible. Patients received cisplatin 20mg/m(2) i.v. daily for three consecutive days, etoposide 75mg/m(2) i.v. daily for three consecutive days and irinotecan 120mg/m(2) i.v. on day 2, every 21 days for six to eight cycles. Administration of G-CSF was given in the presence of febrile neutropenia and as a 5-day prophylaxis around the recorded nadir day in patients who developed grades 3-4 neutropenia. RESULTS Fifty-six patients were assessable. The median age was 62.2 years; 96.4% had PS 0-1, 33.5% had >3 metastatic sites. The overall response rate was 80.4% with 8 (14.3%) patients achieving a complete response. The median time to tumor progression was 7.8 months [95% confidence interval (CI), 7.1-8.6 months] with a median survival of 15.1 months [95% CI, 9.7-20.5 months] and 1-year survival rate of 56.5%. One patient died from toxicity. Grades 3-4 neutropenia occurred in 37.5% of patients, grades 3-4 thrombocytopenia occurred in 10.9% of patients and 11 (19.6%) patients developed febrile neutropenia. Grades 3-4 non-hematological toxicities were primarily nausea-vomiting 3.6%, diarrhea 7.1% and fatigue 3.6%. CONCLUSION This study strongly suggests that cisplatin, etoposide and irinotecan combination is very effective for the treatment of E-SCLC with good safety profile. The triplet regimen currently seems a promising regimen and has to be further explored in phase III trials.
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Affiliation(s)
- D Pectasides
- Second Department of Internal Medicine-Propaedeutic, Oncology Section, University General Hospital Attikon, Athens, Greece.
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Lee JE, Park HS, Jung SS, Kim JO, Cho MJ, Kim JH, Lee CS, Kim SY. Phase II Study of Induction Irinotecan + Cisplatin Chemotherapy Followed by Concurrent Irinotecan + Cisplatin Plus Twice-Daily Thoracic Radiotherapy. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.63.2.154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeong Eun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Hee Sun Park
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Sung Soo Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Ju Ock Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Moon June Cho
- Department of Radiation Oncology, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Jin Hwan Kim
- Department of Radiology, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Choong Sik Lee
- Department of Pathology, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
| | - Sun Young Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University Hospital & Cancer Research Institute, Daejeon, Korea
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Hesketh PJ, McCoy J, Dunphy FR, Bearden JD, Weiss GR, Giguere JK, Atkins JN, Dakhil SR, Kelly K, Crowley JJ, Gandara DR. Phase II Trial of Paclitaxel, Carboplatin, and Topotecan with G-CSF Support in Previously Untreated Patients with Extensive Stage Small Cell Lung Cancer: Southwest Oncology Group 9914. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Phase II Trial of Paclitaxel, Carboplatin, and Topotecan with G-CSF Support in Previously Untreated Patients with Extensive Stage Small Cell Lung Cancer: Southwest Oncology Group 9914. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200611000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Lung cancer was relatively uncommon at the turn of the 20th century, and has increased in prevalence at alarming rates, particularly because of the augmented trend in smoking, so that it is now the most common cause of cancer death in the world. As almost a quarter of these cancers are of small cell in origin, it seems only appropriate that small cell lung cancer receives ample attention, rather than seemingly to have been overlooked over the last 10-15 years. Despite its generally late presentation and high risk of dissemination, it is exceptionally sensitive to chemo-radiotherapy. This review looks at the diverse options of treatment that have been used over the last few years and tries to highlight the best available. As more than 50% of patients diagnosed with lung cancer are over 70 years of age and various studies have shown that older people respond just as well as their younger counterparts, with similar results in response rates, toxicity and outcomes, it is imperative that the older generation are not disregarded in terms of age being a contraindication to therapy.
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Affiliation(s)
- Samantha Cooper
- Department of Thoracic Medicine, University College Hospital, London, UK
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Kawahara T, Nishiyama H, Yamamoto S, Kamoto T, Ogawa O. Protocol consisting of cisplatin, etoposide and irinotecan induced complete pathological remission of primary small cell carcinoma of the bladder. Int J Urol 2006; 13:1251-3. [PMID: 16984565 DOI: 10.1111/j.1442-2042.2006.01521.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 73-year-old man with primary small-cell carcinoma of the bladder was treated by radical cystectomy with neoadjuvant chemotherapy. Pathological complete remission was achieved by combination chemotherapy composed of cisplatin, etoposide and irinotecan. The patient is free of disease 19 months after surgery.
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Affiliation(s)
- Takashi Kawahara
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Park SH, Lee WK, Chung M, Lee Y, Han SH, Bang SM, Cho EK, Shin DB, Lee JH. Paclitaxel versus docetaxel for advanced gastric cancer: a randomized phase II trial in combination with infusional 5-fluorouracil. Anticancer Drugs 2006; 17:225-9. [PMID: 16428942 DOI: 10.1097/00001813-200602000-00015] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Taxanes have clearly demonstrated activities against gastric cancer. We compared the combination of paclitaxel plus 5-fluorouracil (5-FU) (PF) with docetaxel plus 5-FU (DF) as first-line chemotherapy in patients with measurable metastatic gastric cancer. Seventy-seven patients were randomly assigned to receive paclitaxel 175 mg/m2 or docetaxel 75 mg/m2 on day 1, in combination with 5-FU 500 mg/m2 continuous infusion on days 1-5. Treatment was repeated every 3 weeks. Of 314 chemotherapy cycles delivered (median 5 in both groups), dose reduction was required more frequently in the DF group, being 9 and 19%, respectively (P<0.01). PF was associated with, although statistically insignificant, substantially less grade 3 or 4 toxicities than DF (68 versus 85%; P=0.09). Global quality of life was similar in both groups, but substantive differences in many symptom scores including pain, dyspnea, constipation and diarrhea favored PF. There were no significant differences in therapeutic efficacy between PF and DF with respect to response rate (42 versus 33%, respectively; P=0.53), and failure-free (3.6 versus 4.2 months; P=0.92) and overall survival (9.9 versus 9.3 months; P=0.42). Both PF and DF appear to have efficacy against metastatic gastric cancer, with different, but acceptable, safety profiles.
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Affiliation(s)
- Se Hoon Park
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon Medical School Gil Medical Center, Incheon, South Korea
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Kawahara M. Irinotecan in the treatment of small cell lung cancer: a review of patient safety considerations. Expert Opin Drug Saf 2006; 5:303-12. [PMID: 16503750 DOI: 10.1517/14740338.5.2.303] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A water soluble derivative of camptothecin, irinotecan (CPT-11) is effective against small-cell lung cancer (SCLC), as well as non-SCLC and gastrointestinal cancers. This extended review of recently concluded and ongoing studies focuses on irinotecan in the treatment of limited (LD) and extensive (ED) SCLC specifically considering the safety of patients. Irinotecan-induced diarrhoea is pervasive, and can be severe and life-threatening especially in combination with neutropenia. It can have a significant impact on patient quality of life, negatively influencing compliance with therapy and dose-intensity. For LD SCLC, irinotecan can be administered with radiotherapy concurrently or sequentially. In a Phase III study for ED SCLC comparing etoposide and cisplatin (EP) and irinotecan and cisplatin (IP) regimens, severe myelosuppression was more frequent in the EP arm than in the IP arm, and conversely severe or life-threatening diarrhoea was more frequent in the IP arm than in the EP arm. IP resulted in significantly higher response rates and overall survival in Japan, and confirmatory Phase III studies are ongoing. Irinotecan should not be administered to patients with any degree of ongoing diarrhoea above their baseline. Irinotecan can be administered with relative safety for patients with SCLC only through careful patient monitoring, especially regarding diarrhoea and myelosuppression.
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Affiliation(s)
- Masaaki Kawahara
- Department of Medical Services, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasone, Sakai, Osaka, 591-8555, Japan.
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Giaccone G, Smit E. Lung cancer. ACTA ACUST UNITED AC 2005; 22:413-42. [PMID: 16110623 DOI: 10.1016/s0921-4410(04)22019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Giuseppe Giaccone
- Division of Medical Oncology, Vrijie Universiteit Medical Center, Amsterdam and Martini Hospital , Groningnen, Amsterdam, The Netheslands.
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Briasoulis E, Samantas E, Kalofonos H, Skarlos D, Makatsoris T, Christodoulou C, Fountzilas G, Bamias A, Dimopoulos MA, Kosmidis P, Pavlidis N. Phase I study of etoposide, cisplatin and irinotecan triplet in patients with advanced-stage small-cell lung cancer. Cancer Chemother Pharmacol 2005; 56:521-8. [PMID: 15959778 DOI: 10.1007/s00280-004-0994-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Accepted: 11/25/2004] [Indexed: 10/25/2022]
Abstract
AIM The irinotecan-cisplatin combination has emerged as a new standard for the treatment of advanced-stage small-cell lung cancer (AS-SCLC). To move forward we developed a 3-day regimen of cisplatin, etoposide and irinotecan. METHODS Successive cohorts of AS-SCLC patients were treated with irinotecan administered as a single 1-h infusion in combination with fixed doses of cisplatin (20 mg/m(2)) and etoposide (75 mg/m(2)), both given for three consecutive days (ECI regimen). Irinotecan dose was escalated from 60 mg/m(2) by 40-mg/m(2) increments. At mid-step between the maximum tolerated dose (MTD) and the previous dose level, patients were randomized for the day of administration of irinotecan (day 1 vs day 3). RESULTS A total of 36 AS-SCLC patients received 166 courses of treatment at four dose levels. The MTD of irinotecan was 140 mg/m(2) (three dose-limiting toxicities, DLTs), and the recommended optimal dose (ROD) 120 mg/m(2) (two DLTs). DLTs were febrile neutropenia and grade 3 diarrhea. Other toxicities were mild. No difference in toxicity was seen between the two time schedules. A 77% (95% CI 63.25-90.75%) response rate was recorded among 31 evaluable patients and the median survival was 12 months. CONCLUSIONS The ECI regimen was well tolerated and showed considerable activity in patients with AS-SCLC. Phase II/III evaluation is ongoing.
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Affiliation(s)
- E Briasoulis
- Medical Oncology Department, University Hospital, Ioannina, Greece.
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Goto K, Sekine I, Nishiwaki Y, Kakinuma R, Kubota K, Matsumoto T, Ohmatsu H, Niho S, Kodama T, Shinkai T, Tamura T, Ohe Y, Kunitoh H, Yamamoto N, Nokihara H, Yoshida K, Sugiura T, Matsui K, Saijo N. Multi-institutional phase II trial of irinotecan, cisplatin, and etoposide for sensitive relapsed small-cell lung cancer. Br J Cancer 2004; 91:659-65. [PMID: 15280919 PMCID: PMC2364791 DOI: 10.1038/sj.bjc.6602056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Irinotecan (CPT-11) has been shown to exhibit excellent antitumour activity against small-cell lung cancer (SCLC). A multi-institutional phase II study was therefore conducted to evaluate the efficacy and toxicity of CPT-11 combined with cisplatin (CDDP) and etoposide (ETOP) (PEI regimen) for the treatment of sensitive relapsed SCLC. Patients who responded to first-line chemotherapy but relapsed more than 8 weeks after the completion of first-line therapy (n=40) were treated using the PEI regimen, which consisted of CDDP (25 mg m−2) weekly for 9 weeks, ETOP (60 mg m−2) for 3 days on weeks 1, 3, 5, 7, and 9, and CPT-11 (90 mg m−2) on weeks 2, 4, 6, and 8 with granulocyte colony-stimulating factor support. Five complete responses and 26 partial responses were observed, and the overall response rate was 78% (95% confidence interval 61.5–89.2%). The median survival time was 11.8 months, and the estimated 1-year survival rate was 49%. Grade 3/4 leucocytopenia, neutropenia, and thrombocytopenia were observed in 55, 73, and 33% of the patients, respectively. Nonhaematological toxicities were mild and transient in all patients. In conclusion, the PEI regimen is considered to be highly active and well tolerated for the treatment of sensitive relapsed SCLC.
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Affiliation(s)
- K Goto
- Division of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
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Abstract
Small-cell lung cancer (SCLC) accounts for approximately 15% of all cases of lung cancer and is a particularly aggressive form of lung cancer characterised by a poor prognosis, rapid tumour growth, and early metastasis. Roughly, two-thirds of patients with SCLC present with extensive disease (ED) and one-third with limited disease (LD). Combination chemotherapy is the most effective treatment modality for SCLC, and several new agents, including carboplatin, ifosfamide, taxans, and topotecan, have been demonstrated to be active; however, there are no data on the survival benefit of these drugs. A CPT-11+ cisplatin regimen has shown improvement in overall survival over the global gold standard regimen, etoposide + cisplatin (Japanese Clinical Oncology Group: JCOG 9511), and three confirmatory randomised controlled trials are in progress to determine the reproducibility of the JCOG 9511 study. JCOG is evaluating the role of CPT-11 and a new triplet regimen containing CPT-11 in limited-stage SCLC. Strategies and the current protocols of the JCOG are presented and discussed. In the future, it will be essential to evaluate molecular target-based drugs for LD and ED SCLC with new standard combination chemotherapy regimens that include CPT-11.
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Affiliation(s)
- N Saijo
- Internal Medicine and Thoracic Oncology Division, National Cancer Center Hospital, Tuskiji 5-1-1, Chuo-ku, Tokyo 104-0045, Japan.
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Abstract
PURPOSE OF REVIEW Small cell lung cancer was termed chemosensitive with the introduction of combination chemotherapy in the 1970s. However, two decades of trials have seen little significant progress in achieving its "curable" potential. This paper presents an update of data recently published from phase 2 and phase 3 trials. RECENT FINDINGS Platinum and etoposide combination chemotherapy remains the standard of care in small cell lung cancer. New agents, including irinotecan, may improve outcomes, but confirmatory trials are awaited. Triplet therapy, dose intensification, and maintenance therapy have not demonstrated meaningful survival improvements given the increased associated toxicity. Outcomes in limited-stage disease are optimized with the use of concurrent and early chemoradiation. New agents offering an improved toxicity profile for second-line therapy are emerging. SUMMARY Small cell lung cancer remains an aggressive disease. Recent advances have yielded, at best, only modest gains. New strategies are required, including incorporation of novel targeted agents.
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Affiliation(s)
- Kathryn Chrystal
- Department of Medical Oncology, Guy's Hospital, St Thomas Street, London SE1 9RT, UK.
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