Paclitaxel as third-line chemotherapy for small cell lung cancer failing both etoposide- and camptothecin-based chemotherapy

Abstract

Paclitaxel has been shown to have clinical activity in the treatment of small cell lung cancer (SCLC). However, its role as third-line chemotherapy for SCLC after both etoposide- and camptothecin-based regimens has not been clarified.All patients with refractory SCLC who were treated with paclitaxel-based regimen as third-line chemotherapy between 2005 and 2011 in Seoul National University Bundang Hospital were reviewed retrospectively. Forty patients previously treated with both etoposide- and camptothecin-based chemotherapy were included.The median age of the enrolled patients was 67 years (range, 35-86 years). Most patients (77.5%) received cisplatin plus etoposide as first-line therapy, and camptothecins such as irinotecan or topotecan as second-line therapy. Of 34 patients with measurable lesions, 8 patients (23.5%) achieved partial response and 9 (26.5%) had stable disease. The median progression-free survival (PFS) and overall survival (OS) were 2.5 and 5.9 months, respectively. Predictive factors for OS were performance status (PS) (PS <2 vs ≥2; P = .001), the presence of liver metastasis (P < .001), and number of metastatic sites (<3 vs ≥3; P = .047) in univariate analysis. PS and liver metastasis also remained statistically significant in multivariate analysis. Grade 3 or 4 hematologic toxicity was 20% for neutropenia, and 10% for thrombocytopenia. Other common non-hematological toxicities were peripheral neuropathy and mild liver enzyme elevation.Paclitaxel-based chemotherapy showed modest activity in SCLC patients refractory to both etoposide- and camptothecin-based chemotherapy. PS and presence of liver metastasis were predictive of survival after paclitaxel chemotherapy.

Figure 1

Kaplan-Meier survival curves for OS (A) and PFS (B) in a total of patients. The median OS and PFS were 5.9 mo (95% CI, 3.5–8.3 mo) and 2.5 mo (95% CI, 1.2–3.8 mo), respectively. OS = overall survival, PFS = progression-free survival.

Figure 2

Kaplan-Meier survival curves of OS (A) and PFS (B) in comparisons with respect to the response to paclitaxel-based chemotherapy. The median OS in responder versus nonresponder was 7.3 mo (95% CI, 7.1–7.6) versus 4.6 mo (95% CI, 4.3–4.9) and the median PFS in the same analysis of this group was 3.1 mo (95% CI, 0.62–5.5) versus 1.4 mo (95% CI, 0.89–1.8). Responders had significantly prolonged PFS compared with nonresponders. OS = overall survival, PFS = progression-free survival.