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Sarah Jane Slater
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P3.15 - SCLC/Neuroendocrine Tumors (ID 731)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: SCLC/Neuroendocrine Tumors
- Presentations: 2
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.15-003 - Second Line Chemotherapy in SCLC: The West of Scotland Experience (ID 8057)
09:30 - 09:30 | Presenting Author(s): Sarah Jane Slater
- Abstract
Background:
SCLC has a high response rate to first line chemotherapy but this is often short lived. Patients who relapse six months after first line chemotherapy can be retreated with platinum +/- etoposide and patients that relapse early are treated with CAV (cyclophosphamide, doxorubicin and vincristine), Topotecan or best supportive care (BSC). There have been no clinical trials comparing oral Topotecan with iv CAV.
Method:
A retrospective case note review was undertaken of 296 SCLC patients who received second line chemotherapy for recurrent SCLC in the West of Scotland. Results were analysed using STATA version 14.
Result:
SCLC patients that relapsed after first line platinum-based chemotherapy received CAV (n=161), platinum +/-etoposide (n=61), oral topotecan (n=67) and 7 patients received other cytotoxic agents. Median survival for patients who received CAV was 5.1 months (CI 4.1 – 5.7), 6.3 months (CI 5.2-8.6) for platinum/etoposide and 3.0 months (CI 1.9-3.6) for Topotecan. As expected platinum +/- etoposide was superior to CAV (Log rank p = 0.016) and Topotecan (p <0.0001), as these patients had demonstrated platinum sensitivity. CAV appeared superior to Topotecan (p = 0.001) and was better tolerated. 79% of Topotecan patients required a dose reduction versus 29% of CAV patients. 16% of Topotecan, 8% of CAV and no platinum +/- etoposide patients died within 30 days of receiving chemotherapy. 39% of Topotecan and 19% of CAV patients experienced either neutropenic sepsis or myelosuppression requiring a dose reduction or dose delay. There was no difference in time to progression after first line chemotherapy in the CAV and Topotecan populations. Figure 1
Conclusion:
In this West of Scotland retrospective data collection, patients treated with oral Topotecan appear to have a lower median overall survival and experienced more toxicity than those receiving iv CAV.
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P3.15-005 - Third Line Chemotherapy in SCLC: The West of Scotland Experience (ID 8058)
09:30 - 09:30 | Presenting Author(s): Sarah Jane Slater
- Abstract
Background:
Scotland has one of the highest incidences of SCLC globally (cancerresearchuk.org). Lung cancer is the leading cause of cancer related deaths in the UK (cancerresearchuk.org), with SCLC having a worse prognosis than NSCLC and fewer treatment options. Initially, SCLC has a high response rate to first line chemotherapy but rapidly becomes resistant to chemotherapy. There is little evidence to support and guide third line chemotherapy regimens. A West of Scotland (WoS) retrospective database (2007 to 2013) has been developed to gain useful insights into this aggressive disease to improve patient outcomes.
Method:
A retrospective case note review was undertaken of 1325 SCLC patients from the WoS. 58 patients were identified as receiving third line chemotherapy. Information was collected regarding radiological staging, performance status (PS), treatment history, time to progression and survival. Results were analysed using STATA version 14.
Result:
17% of SCLC patients in this WoS database received no chemotherapy, 60% one line (n= 801), 22% (n= 296) two lines, 4% (n=58) three lines and 0.004% (n= 6) four lines of chemotherapy. Of the 58 patients that received third line chemotherapy 28 had Topotecan, 17 CAV, 7 platinum +/- etoposide and 6 included a variety of other cytotoxics. For all patients receiving third line chemotherapy the median survival was 4.7 months (CI 4.1-5.3) and progression free survival was 3.0 months (CI 2.5 – 3.6). Median survival was 3.5 months (CI 2.6- 5.6) for Topotecan, 4.1 months (CI 2.7-5.0) for CAV and 9.0 months (CI 1.8-12.2) for platinum +/ etoposide. 32 (55%) patients received 3 different regimens for each line of chemotherapy, 25 patients (43%) received a platinum-based chemotherapy regimen twice and 1 patient received a platinum based regimen all three lines of chemotherapy. Only 2 patients received a clinical trial novel treatment for their third line therapy.
Conclusion:
SCLC continues to have a poor prognosis with few patients receiving three lines of chemotherapy. The patients that maintain some sensitivity to platinum based chemotherapy tend to have a marginally better response to third line therapy. Clincial trial opportunities for this group of patients were limited. Patients should be enrolled in clinical trials wherever possible.
