Lung Cancer.pdf

212 G.R. Blumenschein, Jr.
toxicity. Cisplatin and carboplatin have been compared in various randomized
trials, and the results support the equivalent efficacy of these 2 drugs.
No single first-line chemotherapy regimen has been found to be best for
all patients with previously untreated extensive-stage SCLC. CAV and EP
are the 2 most commonly used regimens; as noted in the preceding paragraph,
the combination of etoposide and carboplatin is also used, usually in
patients with contraindications to the use of EP. The choice of regimen
should be dictated by the patient’s concomitant medical conditions. Recommended
doses and schedules for these regimens are shown in Table 11–2.
Follow-up during Therapy
Patients with extensive-stage SCLC treated with chemotherapy should
have chest radiography and serum chemistry studies prior to each cycle of
chemotherapy. Every 6 weeks, patients should also have restaging scans
with computed tomography of the chest. A suggested treatment pathway
for extensive-stage SCLC is shown in Figure 11–1.
Outcomes
With combination chemotherapy, overall response rates in patients with
previously untreated extensive-stage SCLC are approximately 80%. However,
complete responses are observed in only 20% to 30% of patients, and
the median survival time after the initiation of chemotherapy is 7 to 10
months. Ultimately, given the poor outcomes seen with current chemotherapy
regimens, all eligible patients should be encouraged to participate
in clinical trials of new chemotherapy regimens.
Duration of Therapy
Because SCLC is chemosensitive, it was common practice until the 1980s
to treat patients with extensive-stage SCLC with repeated courses of
chemotherapy until there was evidence of tumor progression or the patient
developed severe side effects. This approach to therapy evolved over
Table 11–2. First-Line Chemotherapy Regimens for Extensive-Stage SCLC
Cycle
Regimen Component Drugs and Dosages* Length
EP Etoposide 100 mg/m2 days 1–3
Cisplatin 60 mg/m
3 weeks
2 day 1
CAV Cyclophosphamide 1 g/m2 day 1
Doxorubicin (Adriamycin) 50 mg/m
3 weeks
2 day 1
Vincristine 1.4 mg/m2 day 1
EC Etoposide 100 mg/m2 days 1–3
Carboplatin AUC 6 mg/mL/min day 1
3 weeks
AUC indicates area under the curve.
*All agents given intravenously.