Combination chemotherapy with low doses of weekly Carboplatin and oral Etoposide in poor risk small cell lung cancer

Sixty patients with poor prognostic features, either with extensive disease (ED) or limited disease (LD) small cell lung cancer (SCLC), were treated o n an out-patient basis with Carboplatin 80 mg/m(2) weekly for 3 weeks and o ral Etoposide, at a dose of 100 mg, every other day for 21 days. The treatm ent was repeated every 5 weeks. Responding patients with LD were also treat ed with thoracic irradiation and those who achieved complete response (CR) received prophylactic cranial radio-therapy. The overall response rate (KR) was 32.1% with 8.9% CR. The responses were better for LD (RR 58.3%, CR 25% , partial response, PR 33.3%), than those for ED (RR 25%, CR 4.5%, PR 20.5% ). The median time to progression (TTP) was 4.8 months and the median survi val 5.5 months. These poor results could be attributed to the bad performan ce status and the presence of visceral and brain metastases in this group o f patients. The results could also be due to the lower maximum concentratio n (C-max) and higher T-1/2 of Etoposide, as measured in the blood and urine probably due to the modified regimen used in our study and to the organ in sufficiency in this selected group of patients. Although, toxicity was gene rally mild and manageable, two toxic deaths occurred. In conclusion, this r egimen appears to have a lower efficacy in terms of response and survival t han that obtained in other studies using Cisplatin or Carboplatin plus Etop oside in a similar way. Therapy with this regimen, though less toxic, may n ot be a reliable alternative in elderly patients with visceral metastases a nd ECOG performance status greater than or equal to 2. (C) 1999 Published b y Elsevier Science Ireland Ltd. All rights reserved.