Weekly Etoposide and Platinum in Small-Cell Lung Cancer: Hope and Scope for Fragile Patients

Abstract

Introduction Small-cell lung cancer (SCLC) is an aggressive and chemo-sensitive disease. Many patients present in an advanced stage and with a poor performance status (PS). In such a condition, the treatment dilemma due to poor condition advocates alternative treatment approach rather than standard chemotherapy. One way of usual practice is to split the chemotherapy into a weekly schedule. However, there is limited data regarding the actual benefit of weekly chemotherapy. We hypothesize that a weekly chemotherapy with etoposide/platinum combination will be feasible and safe in patients of advanced-stage SCLC with poor PS.

Objectives This study was aimed to determine whether weekly etoposide/platinum chemotherapy is a safe option for patients with advanced stage, poor PS, and SCLC who are otherwise unfit for systemic anticancer therapy.

Materials and Methods We retrospectively analyzed the data of SCLC patients presented to our center from July 2018 to September 2020. We analyzed that treatment, survival, and clinical benefit data. We also analyzed the benefit of weekly etoposide/platinum in otherwise unfit for chemotherapy.

Results One hundred and fifty patients of lung cancer presente to our department between July 2018 and September 2020; SCLC constituted 34% (53 cases). In SCLC patients, the median overall survival was 2.5 months. Fourteen (26%) patients with SCLC were unable to start any oncological intervention. Ten (19%) patients could receive only one cycle of standard 3 weekly chemotherapy. Five patients with an advanced-stage SCLC and an ECOG-PS of 4, otherwise unfit for any systemic anticancer therapy, were started on weekly chemotherapy with etoposide (60–80 mg/m2) and carboplatin (AUC 2). Four patients demonstrated a partial response (PR) while one demonstrated stable disease (SD) after 9 weeks of therapy. Improvement in PS was noted in all patients. Median progression-free survival (PFS) and overall survival (OS) were 137 and 164 days, respectively. Two patients died of disease progression, one died of massive pulmonary embolism, while two were alive and continuing on the same protocol.

Conclusion The weekly etoposide and platinum chemotherapy is a practical and feasible treatment option in patients who are otherwise fragile and unfit for standard-dose chemotherapy.

Keywords

small-cell lung cancer - lung cancer - poor performance status - weekly etoposide/platinum

Publication History

Article published online:
13 August 2021