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Topotecan in the First-Line Treatment of Small-Cell Lung Cancer

There is currently one trial available, testing the activity of topotecan as single-agent first-line treatment in patients with ED SCLC. In this ECOG study from Schiller et al. [1] 48 patients with ED and without brain metastasis and prior chemotherapy were included and received a dose of 2 mg/m2 as a 30-min infusion for 5 days. A total of 4 cycles were repeated in 3-week intervals. While the first 13 patients did not receive any hematopoietic growth factors, the other patients received G-CSF in a dose of 5 mg/kg body weight given from day 6 to 14 because of the substantial hematological toxicity seen in the first subgroup treated without growth factors. In patients with progressive disease or in the case of no change after 2 cycles or partial remission after 4 cycles patients received further treatment with cisplatin 60 mg/m2, day 1, and etoposide 120 mg/m2, days 1–3, in 3-week intervals for further 6–8 cycles. The hematological toxicity of the topotecan treatment is shown in table 1. Of the 13 patients treated without G-CSF, 77% suffered from a neutropenia WHO grade 4 and 38% from thrombocytopenia WHO grades 3/4. In the 35 patients treated subsequently with G-CSF, the hematological toxicity was markedly reduced and limited to a neutropenia WHO grade 4 in only 26%, while the incidence of thrombocytopenia WHO grades 3/4 was identical (37%). Topotecan showed substantial activity in these patients with metastatic SCLC. 19 patients (40%) achieved a partial remission, no change was seen in 17 patients (35%), 6 patients showed progressive disease and 6 patients were not evaluable. Introduction