[Who has Small Cell Lung Cancer?]

It's kinda hard to keep up with those who have SCLC or loved ones with SCLC, especially when this subgroup is not used. It would be nice if a few of you would comment here to let those of us know.

Steve

[Small Cell Diagnosis]

Hi D iane,

I am so sorry for your loss. I saw your post earlier in the week and was uncertain what to say, as I suspect many feel similar. Please forgive my tardiness in expressing my feelings. I have followed your posts, including reading the ones posted before I became a member. Your posts have helped me focus on my wife's cancer. With the limited number of SCLC cases on here, I suspect we read and reread everything in detail. Please know that I appreciated your willingness to post on this forum.

Thank you ... Steve

[Small Cell Diagnosis]

Hi Diane ... sorry I haven't posted in awhile and am sorry to hear about the brain mets.  I see husband is getting WBRT ... has he started yet?  My wife will be getting hippocampus-avoidance PCI (similar) in a couple of weeks for 10 days.  How many brain mets did your husband have?  The reason I ask is that some radiation oncologist prefer SRT if less than 4 BM.  Although it may be different with ES-SCLC.  For LS-SCLC, my wife's brain radiation oncologist prefers PCI/WBRT regardless of BM during the first-line treatment and if BM shows up later in small amounts, would perform SRT.

Steve

[Small Cell Diagnosis]

2 hours ago, just me said:

Hi Diane,

I am not sure how to update the treatment plan the way you do.  But latest scans April 9th, show disease progression. Things are changing,  in the midst of this Corona virus , we received the news over the phone.  My husband will recieve a new chemo treatment ironotecan.  Once a week for three weeks and a repeat scan.  Trying to remain positive and enjoy the day.

just me

Hi just me ... I'm sorry to hear about your husbands cancer progression.

I couldn't find posts about your husband's cancer treatment. Does he have SCLC?  Is the Irinotecan the 2nd-line treatment or 3rd? I am curious about Irinotecan and want to hear more info when you have it.

I sure hope this does the trick for your husband.

Steve

[Small Cell Diagnosis]

Sorry I wasnt more helpful and I was very hesitant about mentioning supportive care information so I didnt. Please forgive me for not doing so.

I will be interested in actual side effects of Topotecan and would certainly like to hear how it goes with your husband, if you are okay with it.

Steve

[Small Cell Diagnosis]

Hi Diane ... I had already looked at some Extended-stage SCLC info trying to see if any might be have bearing on stage IIIB for my wife.

NCCN Guidelines Version 3.2020: ES-SCLC

1st-line - Cisplatin/Carboplatin + Etoposide + Atezolizumab (Tecentriq), followed by maintenance Tecentriq

2nd-line & beyond:

Refractory/resistant (<3mos) - Topotecan (FDA approved) or clinical trial; other - Nivolumab (Opdivo) w or w/o Ipilimumab (Yervoy); Pembrolizumab (Keytruda); Paclitaxel; Docetaxel; Irinotecan; others.

Note: If maintenance on other immunotherapy (Tecentriq), can't use Opdivo, Yervoy, Keytruda.

Sensitive (>3mos) - Topotecan or clinical trial

Sensitive (>6mos) - Cisplatin/Carboplatin + Etoposide only

NCCN discussion:

Patients w/ progressive disease (PD) while on 1st-line treatment w/ Tecentriq should not be treated with additional immune checkpoint inhibitors.

Patients w/ sensitive relapse - Cisplatin/Carboplatin + Etoposide + Irinotecan improved survival over vs Topotecan but NCCN recommends against it due to toxicity profile.

Literature:

Topotecan for Relapse Small-cell Lung Cancer: Systematic Review and Meta-Analysis of 1347 Patients [Scientific Reports 5:15437 DOI: 10.1038/srep15437 October 21, 2015

Conclusion - Topotecan provided a promising outcome for patients w/ sensitive relapse and poor outcome for patients w/ refractory relapse.

Refractory - 6mos OS@37%; 1yr OS@9%; RR@5%; DCR@29% (CR@0%, PR@3%, SD@25%), PD@59%

Sensitive - 6mos OS@57%; 1yr OS@27%; RR@17%; DCR@42% (CR@1%, PR@14%, SD@22%), PD@48%

Treatment Options for Relapsed Small-Cell Lung Cancer: What Progress Have We Made [American Society of Clinical Oncology, Volume 14/Issue 6/June 2018

"For patients who relapse in < 6 months, we favor single-agent chemotherapy with either topotecan.... or paclitaxel. However, the response rate for topotecan in patients with chemo refractory disease is only approximately 10%, so.... we favor paclitaxel... with response rates of up to 29%.

Overall Survival (OS): Total proportion of patients who are alive after a period of time.

Disease Control Rate (DCR): Total proportion of patients that demonstrate a response. It is the sum of complete response (CR), partial response (PR) and stable disease (SD). Progressive disease (PD) is not part of DCR.

Topotecan Symptoms:

Emergency help needed - hives, difficulty breathing, swelling of face, lips, tongue or throat.

Call Dr. at once - fever, chills, body aches or flu-like symptoms; pale skin, easy bruising or bleeding; unusual weakness; white patches or sores inside mouth or lips; skin changes or severe irritation where needle is placed.

Less serious - bruising or swelling at injection site; tired feeling; headache, body pain, muscular or joint pain; mild skin rash ; loss of appetite; nausea, vomiting, constipation or stomach pain; tempory hair loss.

It looks like 1st-line treatment for ES-SCLC hurts the use of further immunotherapy which is different for LS-SCLC in that immunotherapy is not used in 1st-line treatment. I couldn't find any literature to refute this. However, > 3mos but < 6mos (sensitive) appears to have some alternatives to topotecan. If healthy or "up to it", there is adding irinotecan to CE. Also, I would prefer paclitaxel over topotecan for < 3mos relapse and maybe < 6mos relapse.

Note that a clinical trial for Lurbinectedin is available (I think) for 2nd-line treatment of ES-SCLC patients. You might see if this might work.

I have not been a fan of topotecan but there are more options w/ LS-SCLC than ES-SCLC. I hope this info helps in some small way. I'm pulling for you guys.

Steve