OBJECTIVES: Stage IV small cell lung cancer (SCLC) is associated with short survival and progression after first-line systemic therapy frequently occurs within months. Although topotecan is approved for second-line treatment, its efficacy is limited, and treatment heterogeneity exists. MATERIAL AND METHODS: The decision-making patterns for second line treatment of 13 European medical oncologists with expertise in SCLC were analyzed. RESULTS: The two criteria most relevant to decision-making were the performance status and the interval of recurrence since first-line treatment. With an interval of less than 3 months since the end of first-line chemotherapy, 62 % of the experts recommended cyclophosphamide, doxorubicin and vincristine (CAV) for fit patients and 54 % recommended topotecan for unfit patients. For an interval of more than 6 months, a clear consensus for a re-challenge with a platinum doublet was achieved (92 %). However, there was no consensus on the second-line therapy with an interval of 3-6 months since the end of first-line therapy. CONCLUSION: Real world practice may differ from recommendations in general guidelines and cannot always be directly derived from trial results as other factor such as habits, patient's preference, convenience or costs have to be factored in.
- Fruh, M.
- Panje, C. M.
- Reck, M.
- Blackhall, F.
- Califano, R.
- Cappuzzo, F.
- Besse, B.
- Novello, S.
- Garrido, P.
- Felip, E.
- O'Brien, M.
- Paz Ares, L.
- de Marinis, F.
- Westeel, V.
- De Ruysscher, D.
- Putora, P. M.
Keywords
- Decision making
- Objective consensus
- Second-line chemotherapy
- Small cell lung cancer (SCLC)
- from BMS, MSD, AstraZeneca, Boehringer Ingelheim, Roche, Takeda and institutional
- research grants from BMS and AstraZeneca CP: none MR reports honoraria for
- lectures and consultancy from Abbvie, Amgen, AstraZenece, BMS,
- Boehringer-Ingelheim, Lilly, Merck, MSD, Novartis, Pfizer, Roche, Samsung. FB:
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- Ingelheim, Lilly Oncology, Roche, Pfizer, MSD, Bristol Myers Squibb, Takeda and
- Novartis
- institutional grands for conduct of clinical trials or contracted
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- Abbvie, Takeda and Novartis
- stock ownership of The Christie Private Care. FC
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- Health, MSD, Pfizer, Janssen, Boehringer Ingelheim, Novartis, Gilead, Rovi,
- Abbvie, Lilly, Takeda, Sysmex, Blueprint Medicines, and Bayer. EF reports
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- grants from Grant for Oncology Innovation (GOI), Fundacion
- Merck Salud, outside the submitted work
- and Grifols: Independent Member of the
- Board. MOB reports advisory board work for MSD, BMS, BI and Pierre Fabre. LP-A is
- a board member of Genomica and Altum Sequencing, and has received honoraria from
- Roche/Genentech, Eli Lilly, Pfizer, Boehringer Ingelheim, Bristol-Myers Squibb,
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- and travel, accommodations or expenses from
- Roche, AstraZeneca, AstraZeneca Spain, Merck Sharp and Dohme, Bristol-Myers
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- personal fees and other from Roche, personal fees and other from BMS, personal
- fees and other from Astra Zeneca, personal fees from MSD, personal fees from
- Takeda, other from Pfizer, personal fees and other from Boehringer Ingelheim,
- personal fees from Lilly, outside the submitted work. DDR reports outside of this
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- institutional research
- funding from Boehringer Ingelheim, Bristol-Myers Squibb, AstraZeneca, Philips,
- Olink. PMP reports speaker fees from Janssen and institutional educational grants
- from AstraZeneca and Celgene.
