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Epirubicin-ifosfamide combination effective in small cell lung cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – The combination of epirubicin and ifosfamide is effective in patients with relapsed or refractory small cell lung cancer (SCLC), researchers from France report in the August 9th online Lung Cancer.

Both agents have been shown to have clinical activity in the treatment of SCLC, and the combination has shown favorable tolerability in patients with non-small cell lung cancer.

“This study validates in our opinion the use of this specific combination as it has a manageable toxicity and a good response profile,” Dr. Jean-Louis Pujol from Montpellier Academic Hospital, Montpellier, France told Reuters Health in an email. “In addition, our results could be regarded as an additional clue in favor of anthracycline therapy in SCLC.”

Dr. Pujol and colleagues report the effects of a combination of epirubicin and ifosfamide as a non-cross-resistant regimen in 70 patients (median age, 56 years) with relapsed or refractory SCLC after failure of a first line regimen.

Fifteen patients (21.4%) achieved an objective response (including 1 complete response), and 7 patients (10%) had stable disease.

Median overall survival was 3.9 months, which appears lower than that reported in a recent study of topotecan monotherapy (25 weeks).

Most patients (71%) experienced neutropenia, and thrombocytopenia and anemia were also common. There were 3 toxic deaths, 2 from neutropenic infection and 1 from cardiac failure.

High serum neuron-specific enolase (NSE) and the presence of brain metastases were the only independent negative prognostic variables.

“In our opinion, this combination could be proposed to patients with a good performance status, a good cardiac function, and who have had relapsed less than 3 months after end of first line chemotherapy (usually, Cis-etoposide or carbo-etoposide),” Dr. Pujol said. “This combination is also a good third line after failure of topotecan a hydrosoluble analog of camptothecin that is active (and approved) in SCLC relapse.”

“The first line of treatment in this setting depends upon the delay between the end of first line and time of recurrence,” Dr. Pujol explained. “When this duration is 6 months or more, the best is to reinduce the same chemo that had resulted in response induction as first line. Otherwise, our feeling is that, in some cases epirubicin-ifosfamide is the best choice (due to activity of anthracycline in SCLC).”

Lung Cancer 9 August 2011.