%0 Journal Article
%T Treatment Options for Relapsed Small-Cell Lung Cancer: What Progress Have We Made?
%A Angel Qin
%A Gregory P. Kalemkerian
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.18.00278
%X Small-cell lung cancer (SCLC) is an aggressive malignancy that typically exhibits exquisite sensitivity to initial treatment followed by rapid recurrence of relatively resistant disease. One third of patients with SCLC present with limited-stage disease, for which chemoradiotherapy yields a cure rate of approximately 25%. In contrast, both extensive-stage and relapsed SCLC are incurable, and all treatment is given with palliative intent. Despite many clinical trials using a wide variety of cytotoxic regimens and molecularly targeted agents, the prognosis of patients with relapsed SCLC remains dismal, with a median overall survival of < 6 months. In the accompanying article, Gong and Salgia1 present a review of current and upcoming treatment options for patients with relapsed SCLC. Duration of response to initial treatment plays a crucial role in determining subsequent therapy. Chemorefractory disease, defined as relapse within 3 months of completing initial therapy, is associated with poor response to subsequent chemotherapy. Chemosensitive disease, defined as relapse beyond 3 months, is associated with response rates of 20% to 25% for most active cytotoxic agents. Although randomized trials have not addressed optimal therapy on the basis of duration of initial response, current guidelines recommend that patients who relapse > 6 months from initial therapy should be retreated with the original chemotherapy regimen.2 For patients who relapse in < 6 months, we favor single-agent chemotherapy with either topotecan, the only US Food and Drug Administration¨Capproved, second-line therapy, or paclitaxel. The use of topotecan is based on two randomized studies; one reported that it had equivalent efficacy and lower toxicity than combination chemotherapy,3 and the other showed that it was superior to best supportive care.4 However, the response rate for topotecan in patients with chemorefractory disease is only approximately 10%, so in this setting we favor paclitaxel on the basis of small phase II trials with response rates of up to 29%.5 When selecting therapy for individual patients, factors such as duration and depth of initial response, prior treatment-related toxicity, and performance status must be considered. Several newer agents, including temozolomide and bendamustine, have activity in relapsed SCLC. Of note, temozolomide yielded a response rate of 38% for brain metastases due to SCLC.6 Amrubicin has demonstrated high response rates in relapsed SCLC but is not available in the United States. In a phase III trial that randomly assigned patients with
%U http://ascopubs.org/doi/full/10.1200/JOP.18.00278