Advances in chemotherapy for small cell lung cancer: Single-agent activityof newer agents

Small cell lung cancer (SCLC) is a common neoplasm with an extremely poor p rognosis. Patients with extensive-stage disease have a 5-year survival rate of 1% to 2%. Identification of new active chemotherapy agents is of great importance for the development of more effective treatment for SCLC. Severa l new drugs that have established a role in the management of non-SCLC in t he past decade are also active in SCLC. The mean response rates in untreate d versus previously treated patients for these newer drugs are: 26% versus 14% for vinorelbine, 27% versus 14% for gemcitabine, 45% versus 29% for pac litaxel, 22% versus 25% for docetaxel, 39% versus 19% for topotecan, and 50 % versus 16% to 24% for irinotecan. A comparison of the response rates of t hose agents to more established drugs (e.g., cisplatin and etoposide) sugge sts that the newer drugs are equally or more active in previously treated p atients with SCLC. This activity is even more impressive because initial th erapy during the past decade has almost always included platinum and/or an epipodophyllotoxin in the regimen. Furthermore, a recent randomized trial s howed that the combination of a newer agent (irinotecan) with cisplatin was superior to a standard etoposide and cisplatin regimen in patients with ne wly diagnosed extensive-stage SCLC. These data support further evaluation o f the newer chemotherapeutic drugs, and especially the camptothecins (irino tecan and topotecan) and the taxanes (paclitaxel and docetaxel), in the ini tial treatment of SCLC.