Abstract
Background: Lung cancer is the most common cancer worldwide. Platinum based chemotherapy improved the overall survival up to 8-10 months and 1 year survival rate of 33%. Over the past years attention was focused on the possible effect of prolongation of therapy immediately after first line therapy, the so called Maintenance therapy.
Objective: The main objective of this study is to assess the response rate, safety and toxicity profile of oral Etoposide as maintenance therapy in advanced stage Non-Small Cell Lung Cancer (NSCLC).
Methods and Materials: Stage III/IV NSCLC patients who received 4-6 cycles of platinum based chemotherapy and achieved complete (CR), partial (PR) or stable (SD) response were included in the study. The patients were given oral Etoposide 50mg once daily for 14 days repeated every 21 days and evaluated with Chest X-ray, blood counts, biochemistry.
Results: Among the 40 patients who received platinum doublet, 32 patients received maintenance therapy. The mean number of cycles received was 7.5 (ranges from 1 to 27 cycles). Twenty one patients (65.6%) received more than or equal to six cycles. Three patients (9.3%) showed complete response, 4 (12.5%) had partial response and 15 (46.8%) were in the stable disease. Overall response rate was 21.8% and the Disease Control Rate was 68.7%. All patients had grade 1 or 2 toxicity only. The median progression free survival was 5 months.
Conclusion: Oral Etoposide maintenance therapy following Cisplatin based chemotherapy in advanced NSCLC was well tolerated & shows good disease control with less toxicity.
Keywords: Non-Small Cell Lung Cancer, Cisplatin, Etoposide, Maintenance, Progression free survival.
References
- Jemal et al, siegel R, Ward E, Hao Y, Xu J. Cancer Statistics, 2009. Cancer J Clin. 2009:59:225-249.
- Mahesh PA,S. Archana, B.S. Jayaraj, Shekar Patil, S.K. Chaya, H.P. Shashidhar, B.S. Sunitha, and A.K. Prabhakar. Factors affecting 30 month survival in lung cancer patients. Indian J Med Res. Oct 2012; 136(4); 614-621.
- Rajesh Dikshit, Prakash C Gupta, Chinthanie Ramasundarahettige, Vendhan Gajalakshmi, Lukasz Aleksandrowicz, Rajendra Badwe, Rajesh Kumar, SAndip Roy, Wilson Suraweera, Freddie Bray, Mohandas Mallath, Poonam K singh, Direnndra N Sinha, Arun S Shet. Cancer mortality in India: a nationally representative survey. Lancet 2012; 379:1807-16
- Slevin ML, Joel SP, Whomsley R, et al: The effect of dose on the bioavailability of oral etoposide; confirmation of a clinically relevant observation. Cancer Chemother pahrmacol 24:329-331, 1989.
- Ruckdeschel JC, Finkelstein DM, Ettinger DS, et al: A randomized trial of the four most active regimens fo the four most active regimens for metastatic non-small-cell lung cancer. J Clin Oncol 4:14-22, 1986.
- Bonomi P, Kim K, Fairclough D, et al. Comparison of survival and quality of life in advanced non-small-cell lung cancer patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin: results of an Eastern Cooperative Oncology Group trial. J Clin Oncol 2000; 18(3):623.
- Bozoky G, Ruby E, Goher I, Mohos A, Lengyel M, Prolonged oral etoposide therapy in advanced stage lung cancer, Orv Hetil. 1997 Jul 13; 138(28):1791-5.
- Meiyu Fang, Shengye Wang, Yabing Zheng, Xiangmin Kong, Liyan Gong, Youhao Qiu, Yazhen Zhao and Weimin Mao, Maintenance therapy with oral etoposide following first-line docetaxel-cisplatin chemotherapy I metastatic non-small cell lung cancer patients, Bangladesh J Pharmacol 2012; 7: 192-198.
- Clinical practice guidelines for the treatment of unresectable non-small cell lung cancer. Adopted on May 16, 19997 by the American Society of Clinical Oncology, J Clin Oncol 1997; 15(8):2996.
- Bonomi PD, Finkelstein MD, Ruckdeschel JC, et al. Combination chemotherapy vesus single agents followed by combination chemotherapy in stage IV non-small-cell lung cancer: A study of the Eastern Cooperative Oncology Group. J Clin Oncol 1989;7:1602.
- Masters GA, Vokes EE. Should non-small cell carcinoma of the lung be treated with chemotherapy? Pro: chemotherapy is for non-small cell lung cancer. Am J Respir Crit Care Med 1995;151(5):1285.
- Giaccone G. Epidermal growth factor receptor inhibitors in the treatment of non-small-cell lung cancer. J Clin Oncol. 2005; 23: 3235-42.
- Hirsch FR, Kabbinavar F, Eisen T, Martins R, Schnell FM, Dziadziuszko R, Richardson K, Richardson F, Wacker B, Sternberg DW, Rusk J, Franklin WA, Varella-Garcia M, Bunn PA Jr, Camidge DR. A randomized, phase II, biomarker-selected study comparing erlotinib to erlotinib intercalated with chemotherapy in first-line therapy for advanced nonsmall-cell lung cancer. J Clin Oncol. 2011; 29: 3567-73.
- Fukuoka M, Wu YL, Thongprasert S, Sunpaweravong P, Leong SS, Sriuranpong V, Chao TY, Nakagawa K, Chu DT, Saijo N, Duffield EL, Rukazenkov Y, Speake G, Jiang H, Armour AA, To KF, Yang JC, Mok TS. Biomarker analyses and final overall survival results from a phase III, randomized, openlabel, first-line study of gefitinib versus carboplatin/ paclitaxel in clinically selected patients with advanced non- small-cell lung cancer in Asia (IPASS). J Clin Oncol. 2011; 29: 2866-74.
- Regerio C. Lilenbaum and Mark R. Green, Novel Chemotherapeutic Agents in the Treatment of Non-Small-Cell Lung Cancer, J Clin Oncol 11: 1391-1402, 1993.
- Thomas M. Waits, David H. Johnson, John D. Hainsworth, Prolonged administration of Oral Etoposide in Non-Small-Cell Lung Cancer: A Phase II Trail Journal of Clinical Oncology, Vol 10, No 2 (February), 1992: pp 292-296.
- Miller AA, tolley EA, Neill HB, Griffin JP. Pharmacodynamics of prolonged oral etoposide in patients with advanced non small cell lung cancer, J Clin Oncol. 1993 Jun;11(6):1179-88.
- Waits TM, Johnson DH, Hainsworth JD, Hande KR, Prolonged administration of ral etoposide in non-small-cell lung cancer: a phase II trial, J Clin Oncol. 1992 Feb; 10(2): 292-6.
Corresponding Author
Dr K. Kalaichelvi
Madras Medical College
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