What is the optimal concurrent chemotherapy to be used for the treatment of limited stage small cell lung cancer with radiotherapy?

From Cancer Guidelines Wiki

What is the optimal concurrent chemotherapy to be used for the treatment of limited stage small cell lung cancer with radiotherapy?

One phase III trial had demonstrated that the standard three-weekly cisplatin + etoposide regimen was superior to the daily administration of cisplatin plus etoposide in terms of local control and patient tolerance.[1] No advantage of irinotecan plus cisplatin versus cisplatin and etoposide in patients receiving concurrent accelerated hyperfractionated thoracic radiotherapy.[2]

Two phase II trials had demonstrated that the addition of a third agent to the cisplatin-etoposide regimen during radiation therapy provided no additional benefit. Prolonged oral etoposide administration provided no added benefit.[3][4] Hence three-weekly cisplatin etoposide is considered as standard of care with chest radiation therapy.

Meta-analysis has demonstrated that survival time in patients with limited stage disease correlated with the shorter time from the first day of chemotherapy to the last day of chest radiation therapy, supporting prior phase III trials demonstrating the advantage of early versus late chemoradiotherapy.[5]


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Evidence summary and recommendations

Evidence summary Level References
Standard three-weekly cisplatin plus etoposide regimen is superior to the daily administration of cisplatin plus etoposide, in terms of local control and patient tolerance.

Last reviewed August 2015

II, IV [1], [3], [4]
No advantage of irinotecan plus cisplatin versus cisplatin and etoposide in patients receiving concurrent accelerated hyperfractionated thoracic radiotherapy.

Last reviewed August 2015

II [2]
Evidence-based recommendationQuestion mark transparent.png Grade
Platinum plus etoposide is recommended as the chemotherapy backbone for concurrent chemoradiotherapy in patients with limited stage small cell lung cancer.

Last reviewed August 2015

B



Practice pointQuestion mark transparent.png

It is advisable to use three-weekly platinum and etoposide chemotherapy during concurrent chemoradiotherapy for limited stage small cell lung cancer.

Chest irradiation is optimally commenced early during the course of chemotherapy.
Last reviewed August 2015

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References

  1. 1.0 1.1 Sculier JP, Lafitte JJ, Efremidis A, Florin MC, Lecomte J, Berchier MC, et al. A phase III randomised study of concomitant induction radiochemotherapy testing two modalities of radiosensitisation by cisplatin (standard versus daily) for limited small-cell lung cancer. Ann Oncol 2008 Oct;19(10):1691-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18504252.
  2. 2.0 2.1 Kubota K, Hida T, Ishikura S, Mizusawa J, Nishio M, Kawahara M, et al. Etoposide and cisplatin versus irinotecan and cisplatin in patients with limited-stage small-cell lung cancer treated with etoposide and cisplatin plus concurrent accelerated hyperfractionated thoracic radiotherapy (JCOG0202): a randomised phase 3 study. Lancet Oncol 2013 Dec 2 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24309370.
  3. 3.0 3.1 Horn L, Bernardo P, Sandler A, Wagner H, Levitan N, Levitt ML, et al. A phase II study of paclitaxel + etoposide + cisplatin + concurrent radiation therapy for previously untreated limited stage small cell lung cancer (E2596): a trial of the Eastern Cooperative Oncology Group. J Thorac Oncol 2009 Apr;4(4):527-33 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/19240650.
  4. 4.0 4.1 Lee SH, Ahn YC, Kim HJ, Lim DH, Lee SI, Nam E, et al. Early concurrent chemoradiotherapy with prolonged oral etoposide and cisplatin for limited-stage small-cell lung cancer. Jpn J Clin Oncol 2003 Dec;33(12):620-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14769839.
  5. De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, et al. Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer. J Clin Oncol 2006 Mar 1;24(7):1057-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16505424.

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Appendices

Further resources

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