Comparison of Amrubicin and Weekly Cisplatin/Etoposide/Irinotecan in Patients With Relapsed Small-cell Lung Cancer

Limited evidence is available for relapsed small-cell lung cancer (SCLC). Five hundred eighty consecutive patients with relapsed SCLC treated at our institute were analyzed. Multivariate analysis identified sensitive relapse and amrubicin treatment as independent favorable prognostic factors for survival. Amrubicin showed a favorable trend compared with cisplatin/etoposide/irinotecan in terms of the progression-free survival and feasibility in SCLC patients with relapsed disease. Background: Although several agents have been introduced for the treatment of relapsed small-cell lung cancer (SCLC), there is still only limited evidence regarding second-and later-line chemotherapies for these patients. Patients and Methods: Consecutive patients with relapsed SCLC treated at the National Cancer Center Hospital between 2000 and 2014 were analyzed. Patients' characteristics and treatments to explore factors associated with the survival outcomes were reviewed. Results: A total of 580 patients diagnosed as having SCLC received first-line chemotherapy/chemoradiotherapy, of which 343 (59%) received second-line chemotherapy. Among the 343 patients, 193, 148, and 2 patients were diagnosed sensitive relapse, refractory relapse, and relapse of unknown sensitivity status, respectively. Second-line chemotherapy regimens used were as follows: amrubicin (AMR) in 188 (55%) patients; weekly cisplatin/etoposide/irinotecan (PEI) in 56 (16%) patients; topotecan in 18 (5.2%) patients; others in 81 (24%) patients. In the analysis including all patients, the following outcomes were obtained for the patients treated with AMR and PEI, respectively: objective response rate: 51% and 73%; median progression-free survival: 4.5 and 4.2 months; median overall survival: 10.0 and 10.8 months. Multivariate analysis identified sensitive relapse to first-line treatment (vs. refractory relapse) (P=.007) and AMR as second-line treatment (vs. PEI) (P=.005) as independent favorable prognostic factors for survival. Conclusion: AMR showed a favorable trend compared with PEI in terms of the progression-free survival and feasibility in SCLC patients with relapsed disease. Based on our findings, we suggest that a randomized trial comparing AMR and PEI is warranted. (C) 2016 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license