Author of

• 16879

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  P1.07 - Poster Session with Presenters Present (ID 459)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: SCLC/Neuroendocrine Tumors
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16887

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    P1.07-008 - Lomustine Endoxan VP16 as Second or Further Line for Recurrent or Progressive Brain Metastases from SCLC (ID 6153)

    14:30 - 14:30  |  Author(s): C. Dubos
    • Abstract

    Background:
    Up to fifty percent of patients with small-cell lung cancer (SCLC) will experience brain metastases (BM) during the whole course of their disease. The oral regimen Lomustine Cyclophosphamide Etoposide (LCE) has been tested in SCLC as second line treatment and was shown to be equivalent to the intravenous regimen Cyclophosphamide Adriamycin Vincristine (Gervais R et al. Clin Lung Cancer 2015;16:100-5). This retrospective study evaluates the cerebral response rate (CRR) of this oral chemotherapy on brain metastases (BM) from SCLC relapsing after platinum-based chemotherapy.
    
    Methods:
    Patients with disease progression after one or more prior chemotherapy regimens for SCLC were included if they had at least one measurable BM according to RECIST 1.1, with PS<2. Patients with symptomatic BM were eligible. They were excluded if they had received previous whole brain irradiation before LCE or were receiving concomitant brain irradiation. Patients received the chemotherapy according to modalities described in the GFPC-0501 study (1). The doses were determined by a therapeutic risk level: lomustine, 80 to 120 mg on day 1, cyclophosphamide 100 mg/d, and etoposide 75 mg/d, for 6 to 14 days, every 28 days, until progression or major toxicity. Primary prophylactic granulocyte colony-stimulating factor was recommended. The primary objective was the cerebral response rate (CRR) using RECIST 1.1 .Secondary objectives included the extra-cerebral response rate (ECRR), the overall survival and the safety.
    
    Results:
    From 2008 to 2014 in Baclesse comprehensive cancer center, 24 patients fulfilled the inclusion criteria. The median age was 57.5 years (interquartile range [IR] 51.5–64.5). CCR was 50% while ECRR was 26% (NS, p=0.135). Interestingly, 8 of the 9 patients with neurological symptoms had symptomatic improvement. Previous treatment (chemotherapy and/or radiotherapy) for BM did not appear to have any effect on CRR (p=1.000). The hematologic toxicities were the most common side effects with neutropenia (grade ¾ : 26%) and thrombocytopenia (grade ¾ : 21%). Median overall survival was 6.3 months.
    
    Conclusion:
    In our study, Lomustine Cyclophosphamide Endoxan has a high activity on BM from SCLC, with a comparable extra cerebral response rate than others regimen currently used in second line setting. It has a manageable toxicity profile and the oral route allows patients with a short expectancy of life to benefit from a home-delivered treatment. We suggest that this combination should be tested in a prospective study.