The role of second-line chemotherapy in small cell lung cancer: a retrospective analysis

Konstantinos Zarogoulidis,¹ Efimia Boutsikou,¹ Paul Zarogoulidis,^1,2 Kaid Darwiche,² Lutz Freitag,² Konstantinos Porpodis,¹ Dimitrios Latsios,¹ Theodoros Kontakiotis,¹ Haidong Huang,^3,4 Qiang Li,⁴ Wolfgang Hohenforst-Schmidt,⁵ Maria Kipourou,¹ J Francis Turner,⁶ Dionysios Spyratos<sup>1

1</sup>Pulmonary Department, “G Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; ²Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany; ³Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, Detroit, MI, USA; ⁴Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People’s Republic of China; ⁵II Medical Clinic, “Coburg” Regional Hospital, University of Wuerzburg, Coburg, Germany; ⁶Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, NV, USA

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: A total of 535 patients continued with follow-up or best supportive care if needed, and 229 patients who progressed after the completion of first-line chemotherapy were treated with second-line chemotherapy at the time of progression. In total, 103/229 patients received paclitaxel 190 mg/m² and carboplatin 5.5 area under the curve while 126/229 patients received etoposide 200 mg/m² and carboplatin 5.5 area under the curve every 28 days.
Results: Patients administered second-line chemotherapy lived significantly longer, with a median survival of 422 days compared to 228 days in patients with best supportive care alone (P<0.001). Patients who received paclitaxel as second-line chemotherapy lived for an average of 462 days (95% confidence interval: 409–514), versus 405 days in the etoposide group (95% confidence interval: 371–438), which was not statistically significant (P =0.086). The overall response rate was 8% for the paclitaxel group and 6% for the etoposide group. Patients with progression of the disease in more than 3 months had significantly better survival compared with those that progressed in less than 3 months (P<0.001).
Conclusion: Continuation with carboplatin/paclitaxel or carboplatin/etoposide as second-line chemotherapy has no significant survival impact, and it did not improve response rates.

Keywords: SCLC, lung cancer, second-line