Irinotecan and cisplatin for extensive sclc

[teriw]

I'm wondering if anyone can shed some insight on something I recently read.

In a book I received from the Lung Cancer Alliance ("101 Questions and Answers about Lung Cancer" updatd 2006), it says that for extensive sclc, the standard front-line treatment has been carboplatin or cisplatin with etoposide. But that recently, there is thought that cisplatin with irinotecan might be better. The book does say that those results are somewhat preliminary.

Has anyone had this new treatment or learned anything about it? My hubby is about to start his second cycle of carboplatin/etoposide tomorrow. I'm still in that "is he really getting the best there is" place, and seeking any information I can get to question the docs about.

Thanks for listening,

Teri

[mary colleen]

Teri,

The following article from 6/2006 on the Medscape website indicates that the two regimens are pretty comparable in outcome. (I tried to do it as an attachment, but that was over my head!)

NEW YORK (Reuters Health) Jun 16 - A combination of irinotecan and cisplatin (IP) appears to be as effective as etoposide and cisplatin (EP) in patients with previously untreated extensive small-cell lung cancer, according to US and Australian researchers.

"The IP regimen, in the dose and schedule given in our study," lead investigator Dr. Nasser Hanna told Reuters Health, "demonstrated comparable activity to the EP regimen in terms of response rate, time to disease progression, and overall survival. Those in the IP arm had less neutropenia and neutropenic fever, but higher rates of diarrhea, nausea and vomiting."

In the May 1st issue of the Journal of Clinical Oncology, Dr. Hanna of Indiana University, Indianapolis and colleagues report on their study involving 221 patients who were randomized to IP and 110 who were randomized to receive EP.

Side effects included neutropenia in 36.2% of IP patients versus 86.5% of those given EP. However, 21.3% of the IP patients had diarrhea versus none of the EP group.

There was no significant difference in overall response (48% versus 43.6%), median time to progression or overall survival.

Thus concluded Dr. Hanna, "either regimen should be considered an acceptable standard treatment for patients with extensive stage small cell lung cancer."

In an accompanying editorial, Dr. Michael C. Perry of the University of Missouri, Columbia, agrees, noting that although there was greater hematologic toxicity with ER there was more gastrointestinal toxicity with IR. Other responses were similar.

[Sheri]

Teri,

From what I understand Irinotecan (Camptosar) and Cisplatin is not a new treatment. I think it's been about 20 years since SCLC has received a new first line treatment. My Dad, though limited SCLC, was treated with Carbo/Vp-16 (Etoposide)treatment as first line and Carbo is considered a gentler Cisplatin. He achieved remission and now he is on Irinotecan and Cisplatin for second line and it has been effective.

If you haven't already, look up CindyRN's profile. She was extensive with mets to the adrenal and she had Irinotecan and Cisplatin first line then Carbo/Etoposide second line. She's now in remission. You're husband sure is lucky to have you to ask all the tough questions! Good luck to you guys and I hope he achieves remission soon.

[teriw]

Thank you for the information.

Mary, the article was helpful -- thank you for taking the time to find it and paste it in. My best wishes for your husband. The weight thing is difficult. My husband is struggling with that too, although we seem to have him staying around the same weight, but he really should gain about 8 or 10 pounds.

Sheri, thank you for the information you shared also. This definitely helps. Thanks for your thoughts -- I hope your dad has another remission soon too.

There's so much to learn -- it's like we're supposed to become experts over night. Every time I learn something new, I have 100 more questions!

Teri

[john]

I seem to recall that CPT-11 (Irinotecan) is supposed to work a little better in Asians, because of some genetic differences.

Not 100% on this though

[teriw]

Thanks everyone for the information. Yes, I read about a study conducted in Japan using Irinotecan. I think they used higher dosages than we do here, so they had a slightly different outcome in their study than we did here.

We had a talk with our doc yesterday and now feel confident in our treatment plan. He also explained that because Bill won't be getting the radiation up front, he will be able to tolerate higher doses of the carboplatin/etoposide.

Thanks again to everyone!

Happy Thanksgiving!

[DrWest]

I think most of the highlights have already been well covered in the comments, but I've written a summary of the recent history and current ideas on best management of ED-SCLC on my website. It's available here:

http://onctalk.com/2006/11/26/old-and-n ... sive-sclc/

There are also several newly written articles on other aspects of SCLC elsewhere on the website.