Small Cell Lung Cancer Research

Feasibility of Topotecan in the treatment of relapsed small cell lung cancer patients with poor performance status. 1

Relapse Small Cell Lung Cancer (SCLC) patients find it difficult to tolerate chemotherapy again (i.e. second-line chemotherapy) due to poor Performance Status (PS) at the time of relapse. Keeping this in mind, researchers conducted a clinical trial in 2004 on relapse SCLC patients to assess the feasibility of administering second-line chemotherapy using Topotecan to them.

479 patients who were given second-line Topotecan. Out of this, 381 patients had a PS 0/1 and 98 patients had a PS 2 (0 being best PS). Topotecan was well tolerated by both patient groups. Toxicities were generally manageable.
Progression free survival rate with Topotecan
The median overall survival time was shorter in patients with worse PS scores; the median overall survival times were 36.3 weeks, 25.4 weeks, and 16 weeks for PS 0, PS 1, and PS 2 patients, respectively.

In conclusion, treatment with Topotecan is feasible and well tolerated in patients with relapsed SCLC with suboptimal PS scores.

Effectiveness of Using Bevacizumab with Topotecan in Increasing Progression Free Survival in Patients Suffering from Small Cell Lung Cancer 2

A clinical trial study was done by GlaxoSmithKline in 2012 on 50 Small Cell Lung Cancer (SCLC) patients to see if usage of the drug Bevacizumab in addition to Topotecan was beneficial in Progression Free Survival among these patients.

The combination of these two drugs was given to the patients for 3 months after which their response was measured and progression free survival was also seen to know if the drug combination was effective in improving prognosis.

Treating small cell lung cancer with Bevacizumab and Topotecan

The following observations were made at the end of the treatment period (3 months):

  • 65% of the patients to whom this treatment was given showed Progression Free Survival at the end of 3 months i.e. there was no further growth or spread in their cancer.
  • The average overall survival for these patients was 32 weeks.

The same effects were measured for the long term – till progression of disease or death, upto a period of 82.4 weeks:

  • 16% subjects showed some response to this treatment in terms of reduction in size or spread of tumor.
  • In 40% patients, the disease was stable with no improvement or worsening.

Additionally, there was progression of disease i.e. aggravation of the tumor in 26% of the patients.

Bevacizumab and Topotecan is beneficial in short term alleviation of symptoms and disease. However, it cannot be said with confidence that this treatment is beneficial in long term progression free survival in patients with Small Cell Lung Cancer.

Effectiveness of Bevacizumab in Treatment of Small Cell Lung Cancer Patients who are undergoing Chemotherapy? 3

A clinical trial conducted by Genentech in 2011 aimed to assess if use of the drug Bevacizumab was beneficial to Small Cell Lung Cancer (SCLC) patients who are on chemotherapy. The trial was conducted on 102 SCLC patients who were divided into 2 groups:

1. Group 1 (52 patients) were given chemotherapy and Bevacizumab
2. Group 2 (50 patients) were given chemotherapy and Placebo (i.e. they were not being given Bevacizumab but were under the impression that they were given the drug).

It was a double blind study i.e. neither the participants nor the investigators were aware of the masked interventions i.e. whether real drug (bevacizumab) was being given or placebo was being given. This is done in this type of studies to avoid any kind of bias on part of either participant or investigator and thus ensure accurate study results.

Treating small cell lung cancer with Bevacizumab

Graph 3 shows that participants of Group 1 (Bevacizumab+Chemotherapy) had higher progression free survival as well as overall survival compared to the other group which was not given Bevacizumab.

sclc treatment response with Bevacizumab

Also, subjects who were given Bevacizumb responded better and longer to the treatment (ref: Graph 4).

Administering Bevacizumab along with ongoing chemotherapy in SCLS patients seems beneficial in improving their treatment response and longevity.

Comparison of Two Popular Combination Chemotherapy Regimens in Treating Patients With Extensive-Stage Small Cell Lung Cancer 4

Chemotherapy drugs fight cancer by inhibiting the growth of tumors and different drugs do it differently and for various reasons certain combinations works better than others. The Eastern Cooperative Oncology Group conducted a clinical trial to understand if one of the 2 chemotherapy combinations – (Topotecan/Etoposide/Cisplatin/G-CSF) and (Irinotecan/Cisplatin/Etoposide) is decidedly better than the other.

Group 1 received

  • Topotecan intravenously (IV) over 30 minutes on days 1-3
  • Etoposide IV for 1 hour followed by Cisplatin IV for an hour on days 8, 9 and 10
  • Filgrastim (G-CSF) subcutaneously daily beginning on day 11 and continuing until blood counts recover.

Group 2 received

  • Irinotecan IV over 90 minutes and cisplatin IV over 60 minutes on days 1 and 8
  • Oral etoposide twice daily on days 3 and 10 of each cycle.

treatment response with chemo regimens involving Topotecan-Etoposide-Cisplatin-G-CSF-Irinotecan

More number of Group 1 patients responded (reduction or disappearance in tumor lesions) to the treatment compared to Group 2 (ref: Graph 5).

The chemotherapy regimen which was given to Group 1 (Topotecan + Etoposide + Cisplatin + G-CSF) seems to be more beneficial than that given to Group 2 (Irinotecan + Etoposide + Cisplatin) for improving the treatment response and overall longevity of SCLC patients.

Effectiveness of Administering Combination of Topotecan and Carboplatin in People with Extensive Disease Small Cell Lung Cancer 5

A clinical research study conducted in 2009 by GloxoSmithKline on Small Cell Lung Cancer (SCLC) patients aimed to find out if giving them a weekly dose of Topotecan+Carboplatin was effective in bringing good treatment response. For this, 33 SCLC patients were enrolled in the study and were given Topotecan and Carboplatin intravenously every 21 days (Weekly dose of Topotecan on Day 1 and Day 8, Weekly dose of Carboplatin on Day 1).
treatment response to Topotecan and Carboplatin in sclc
As can be seen from the chart above, considerable proportion of the subjects showed partial response 24.2% (reduction in size and spread of tumor lesions), stable disease 33.4% (no improvement/worsening of tumor) while in some patients disease progression 18.2% (aggravation of tumor) was seen. However, in 24.2% of patients, response could not be measured.

Intravenous administration of Topotecan + Carboplatin seems to be a positive and beneficial treatment option for enhancing treatment response in SCLC patients.

How effective is Cisplatin, Etoposide, and Bevacizumab in Treating Patients with Previously Untreated Extensive Stage Small Cell Lung Cancer? 6

National Cancer Institute (NCI) conducted a clinical trial in 2014 to assess the effectiveness of the drugs Cisplatin, Etoposide and Bevacizumab when used together for treating patients with previously untreated extensive stage Small Cell Lung Cancer (SCLC).

All the 63 SCLC patients who were enrolled in the clinical trial were given Cisplatin + Etoposide + Bevacizumab and their treatment response, progression free survival at 6 months and overall survival (up to 3 years) was measured to see the effectiveness of the drug treatment.
Cisplatin, Etoposide and Bevacizumab used in treatment of SCLC
As shown in the Graph, more than half of the patients enrolled in the study gave complete/partial response to treatment i.e. had disappearance/reduction in tumor lesions. Also, nearly half of those who gave good treatment response were progression free at the end of 6 months after treatment was started. These patients were followed up for 3 years and their average overall survival was 10.9 months.

The combination of Cisplatin, Etoposide, and Bevacizumab seems helpful in improved treatment response and enhanced progression free survival among extensive stage SCLC patients.

Is Dasatinib effective in treating patients who have Relapsed Small Cell Lung Cancer (SCLS)? 7

The National Cancer Institute conducted a study in 2014 on patients who had relapse small cell lung cancer to see how well the drug Dasatinib works in treating these patients. Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

A total of 43 such patients were enrolled in the study and effect of Dasatinib on their disease was observed.
dastanib in small cell lung cancer treatment
The following results emerged:
• Progression Free Survival was seen in 43% patients after 6 weeks of treatment (ref: Graph 1).
• Average duration of Progression Free Survival among the patients was 5.9 weeks.
• The average Overall Survival among these patients was 17 weeks.
• Patients were evaluated upto 3 years after start of treatment. During this time,   65.1% patients showed progression of disease, and 16.3% had stable disease (ref: Graph 9).
• Severe adverse effects of treatment were reported by nearly 27% of the subjects.

Dasatinib can be considered as a potent treatment option for patients with relapse Small Cell Lung Cancer as it may aid progression free survival.

References:

  1. ncbi.nlm.nih.gov/pubmed/15047921
  2. clinicaltrials.gov Trial Identifier: NCT00698516; Last verified: March 2011; Sponsor: GlaxoSmithKline
  3. clinicaltrials.gov Trial Identifier: NCT00403403; Last verified: April 2011; Sponsor: Genentech
  4. clinicaltrials.gov Trial Identifier: NCT00057837; Last verified: January 2013; Sponsor: Eastern Cooperative Oncology Group
  5. clinicaltrials.gov Trial Identifier: NCT00316186; Last verified: October 2009 ; Sponsor: GlaxoSmithKline
  6. clinicaltrials.gov Trial Identifier: NCT00403403; Last verified: April 2011; Sponsor: Genentech
  7. clinicaltrials.gov Trial Identifier: NCT00470054; Last verified: June 2014; Sponsor: National Cancer Institute (NCI)

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