Tuberc Respir Dis.  2007 Aug;63(2):154-164. 10.4046/trd.2007.63.2.154.

Phase II Study of Induction Irinotecan + Cisplatin Chemotherapy Followed by Concurrent Irinotecan + Cisplatin Plus Twice-Daily Thoracic Radiotherapy

• Lee JE
• Park HS
• Jung SS
• Kim JO
• Cho MJ
• Kim JH
• Lee CS
• Kim SY

• KMID: 1910094
• DOI: http://doi.org/10.4046/trd.2007.63.2.154

Abstract

BACKGROUND: Irinotecan hydrochloride, a topoisomerase I inhibitor, is effective against small-cell lung cancer. Irinotecan also can act as a potential radiation sensitizer along with cisplatin. To evaluate efficacy and toxicity of irinotecan plus cisplatin (IP) with concurrent thoracic radiotherapy, we conducted a phase II study of IP followed by concurrent IP plus hyperfractionated thoracic radiotherapy in patients with previously untreated limited-stage small-cell lung cancer.
METHODS
Twenty-four patients with previously untreated small-cell lung cancer were enrolled onto the study since November 2004. Irinotecan 60 mg/m2 was administered intravenously on days 1 and 8 in combination with cisplatin 60 mg/m2 on day1 every 21 days. From the first day of third cycle, twice-daily thoracic irradiation (total 45 Gy) was given. Prophylactic cranial irradiation was given to the patients who showed complete remission after concurrent chemoradiotherapy. Restaging was done after second and sixth cycle with chest CT and/or bronchosocpy.
RESULTS
Up to November 2004, 19 patients were assessable. The median follow-up time was 12.5 months. A total of 99 cycles (median 5.2 cycles per patient) were administered. The actual dose intensity values were cisplatin 19.6 mg/m2/week and irinotecan 38.2 mg/m2/week. Among the 19 patients, the objective response rate was 95% (19 patients), with 9 patients (47%) having a complete response (CR). The major grade 3/4 hematological toxicities were neutropenia (35% of cycles), anemia (7% of cycles), thrombocytopenia (7% of cycles). Febrile neutropenia was 4% of cycles. The predominant grade 3/4 non-hematological toxicities was diarrhea (5% of cycles). Toxicities was not significantly different with concurrent administration of irinotecan and cisplatin with radiotherapy, except grade 3/4 radiation esophagitis (10% of patients). No treatment-related deaths were observed. The 1-year and 2-year survival rate of eligible patients was 89% (16/18) and 47% (9/18), respectively.
CONCLUSION
Three-week schedule of irinotecan plus cisplatin followed by concurrent IP plus hyperfractionated thoracic radiotherapy is an effective treatment for limited disease small-cell lung cancer, with acceptable toxicity.

Keyword

Cisplatin; Irinotecan; Limited-disease; Small cell lung cancer; 3-week cycle; Chemotherapy-naive; Twice-daily thoracic radiotherapy; Concurrent chemoradiotherapy

MeSH Terms

Anemia
Appointments and Schedules
Chemoradiotherapy
Cisplatin*
Cranial Irradiation
Diarrhea
DNA Topoisomerases, Type I
Drug Therapy*
Esophagitis
Febrile Neutropenia
Follow-Up Studies
Humans
Lung Neoplasms
Neutropenia
Radiotherapy*
Small Cell Lung Carcinoma
Survival Rate
Thrombocytopenia
Tomography, X-Ray Computed
Cisplatin
DNA Topoisomerases, Type I