AB 41. The role of second line chemotherapy in small cell lung cancer

Background: To evaluate the benefit of second line chemotherapy with platinum based treatment in patients with recurrent small cell lung cancer (SCLC).

Patients and methods: Among 764 patients first diagnosed with SCLC, 535 patients received first-line platinum based chemotherapy for a maximum of eight cycles and they continued with follow up or best supportive care if needed and 229 patients after the completion of first line chemotherapy treated with second line chemotherapy depended on their response: 103/229 patients received paclitaxel 190 mg/m² and carboplatin 5.5 AUC while 126/229 patients received etoposide 200 mg/m² and carboplatin 5.5 AUC.

Results: Patients administered second-line chemotherapy lived significantly longer with median survival 422 days compared to 228 days in patients with best supportive care only (P<0.001). The best supportive care patients had significantly worse PS status. Patients who received paclitaxel as second line chemotherapy lived 462 days (95% CI, 409-514), versus 405 days in etoposide group (95% CI, 371-438), statistically not significant (P=0.086).Overall response rate was 8% for paclitaxel group and 6% for etoposide group. From the 103 pts who received paclitaxelcarboplatin as second line chemotherapy, 85 pts received the same agents as first line treatment with initial response 47%.

Conclusions: Patients administered second-line chemotherapy had significantly longer survival than patients administered best supportive care. The continuation with paclitaxel or etoposide as second line chemotherapy has no significant survival impact and did not improve responses rates.