Irinotecan, topotecan, paclitaxel or docetaxel for second-line treatment of small cell lung cancer: a single-center retrospective study of efficiency comparation and prognosis analysis

Abstract

Background: The main aim of this study was to evaluate the efficiency of second-line chemotherapy irinotecan (CPT-11), topotecan (TPT), paclitaxel (PTX) and docetaxel (DTX) in small cell lung cancer (SCLC) patients who have failure to the first-line standard treatment. The secondary aim was to evaluate the independent prognostic factors of patients who received a second line treatment.

Methods: Retrospective analysis of 116 patients who received second-line chemotherapy. Patients were divided into 4 groups according to the therapy they were treated with, which were CPT-11, TPT, PTX and DTX. Progress free survival (PFS), overall survival (OS), objective response rate (ORR) and disease control rate (DCR) were evaluated for each group. Patients' data of clinical character and blood index were collected, and the prognostic factors were assessed both at univariate and multivariate levels.

Results: Patients treated with CPT-11 achieved the best median PFS and OS of 91 and 595 days, while the median PFS of TPT, PTX and DTX were 74.5, 81 and 50 days respectively. The median OS of them were 154, 168.5 and 184 days respectively. The survival curves of OS were significantly different (P=0.0069). The reaction to second-line therapy is positively correlate to the reaction to first-line therapy (P=0.012). In the multivariate analysis, treatment free interval (TFI) <90 days, lactate dehydrogenase (LDH) ≥225 U/L, neutrophil-to-lymphocyte ratio (NLR) ≥3.5 were identified as independent risk factors for poor prognosis in second-line SCLC patients.

Conclusions: Second-line chemotherapy with TPT in SCLC patients may provide better overall survival benefits. TFI <90 days, LDH ≥225 U/L and NLR ≥3.5 are independent risk factors for second-line SCLC patients.

Keywords: Second-line therapy; docetaxel; irinotecan; paclitaxel; prognostic factor; small cell lung cancer (SCLC); topotecan.

Figure 1

Response (DCR, ORR) in different second-line therapy groups. CPT-11, irinotecan; TPT, topotecan; PTX, paclitaxel; DTX, docetaxel; ORR, objective response rate; DCR, disease control rate.

Figure 2

The survival analysis of different second-line therapy groups. (A) PFS in different second-line therapy groups. The medium PFS of CPT-11, TPT, PTX, DTX was 91, 74.5, 81, 50 days respectively. (B) OS in different second-line therapy groups. The medium OS of CPT-11, TPT, PTX, DTX was 595, 154, 168.5, 184 days respectively. CPT-11, irinotecan; TPT, topotecan; PTX, paclitaxel; DTX, docetaxel.

Figure 3

OS of patients with different TFI (TFI ≥90 days and TFI <90 days). The medium OS of patients with TFI ≥90 days and TFI <90 days was 288 and 172.5 days. TFI, treatment free interval.