Extending first-line platinum and etoposide (PE) beyond four cycles (4c) does not deliver clinical benefit in patients with stage IV small-cell lung cancer (SCLC). That is the finding of a study carried out by the Clatterbridge Cancer Centre in Wirral and the University of Liverpool.
In SCLC, current evidence suggests that more chemotherapy does not translate to more clinical benefit. Strategies increasing chemotherapy dose intensity, dose density, peak dose or total dose regimens have been studied extensively and failed to provide a survival advantage. The length of first-line PE treatment, however, remains controversial.
This new retrospective observational study included patients with stage IV SCLC receiving non-concurrent first-line PE chemotherapy between 2008 and 2015 at the Merseyside and Cheshire Cancer Network. A total of 241 patients received 4c and 69 received >4c.
There were no statistically significant differences between the groups when comparing clinical outcomes.
The median duration of response (time from last chemotherapy cycle to progression) was five months in both groups (hazard ratio [HR], 1.22; 95% CI, 0.93-1.61). Median progression-free survival (time from diagnosis to radiological progression) was eight months in the group receiving 4c versus nine months in the group receiving >4c (HR, 0.86; 95% CI, 0.66-1.13). Median overall survival was 11 versus 12 months in groups receiving 4c versus >4c, respectively (HR, 0.86; 95% CI, 0.66-1.14).
The authors say the results highlight a lack of clinical benefit in extending first-line PE treatment in stage IV disease and support limiting treatment to 4c until superiority of a longer regimen is identified in a randomised study.