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Irinotecan Plus Carboplatin Versus Oral Etoposide Plus Carboplatin in Extensive Small-Cell Lung Cancer: A Randomized Phase III Trial

Andreas Hermes, Bengt Bergman, Roy Bremnes, Lars Ek, Sverre Fluge, Christer Sederholm, Stein Sundstrøm, Lars Thaning, Jan Vilsvik, Ulf Aasebø, Sverre Sörenson

From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart and Lung Division, University Hospital, Lund; Department of Pulmonary Medicine, University Hospital, Linköping; and Department of Pulmonary Medicine, University Hospital, Örebro, Sweden

Corresponding author: Andreas Hermes, MD, Grosshansdorf Hospital, Department of Pulmonary Oncology, Wöhrendamm 80, 22927 Grosshansdorf, Germany; e-mail: pahermes{at}hotmail.com

Purpose A Japanese randomized trial showed superior survival for patients with extensive-disease (ED) small-cell lung cancer (SCLC) receiving irinotecan plus cisplatin compared with etoposide plus cisplatin. The present trial evaluated the efficacy of irinotecan plus carboplatin (IC) compared with oral etoposide plus carboplatin (EC).

Patients and Methods Patients with ED SCLC were randomly assigned to receive either IC, which consisted of carboplatin (area under the curve = 4; Chatelut formula) and irinotecan (175 mg/m2) intravenously both on day 1, or EC, which consisted of carboplatin as in IC and etoposide (120 mg/m²/d) orally on days 1 through 5. Courses were repeated every 3 weeks with four cycles planned. Doses were reduced by one third in patients with a WHO performance status (PS) of 3 to 4 and/or age older than 70 years. Primary end point was overall survival (OS). Secondary end points were quality of life (QOL) and complete response (CR) rate.

Results Of 220 randomly assigned patients, 209 were eligible for analysis (IC, n = 105; EC, n = 104). Thirty-five percent were older than 70 years, and 47% had a PS of 2 to 4. The groups were well balanced with respect to prognostic factors. OS was inferior in the EC group (hazard ratio = 1.41; 95% CI, 1.06 to 1.87; P = .02). Median survival time was 8.5 months for IC compared with 7.1 months for EC. One-year survival rate was 34% for IC and 24% for EC. CR was seen in 18 IC patients compared with seven EC patients (P = .02). There were no statistically significant differences in hematologic grade 3 or 4 toxicity. Grade 3 or 4 diarrhea was more common in the IC group. QOL differences were small, with a trend toward prolonged palliation with the IC regimen.

Conclusion IC prolongs survival in ED SCLC with slightly better scores for QOL.

Supported by the Norwegian Cancer Society and by unrestricted grants from Sanofi-Aventis and Pfizer Inc.

Presented in part at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL, and at the 12th World Conference on Lung Cancer, September 2-6, 2007, Seoul, South Korea.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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