Background: Etoposide-/platinum-based chemotherapy is the standard first-line treatment for extensive-disease small cell lung cancer (SCLC), but responses are short-lived and subsequent options limited. Here, we present our experience with paclitaxel in advanced treatment lines. Methods: We retrospectively studied the clinical course of all paclitaxel-treated SCLC patients between 2005 and 2015 in our institution. Prognostic and predictive factors were analyzed by Kaplan-Meier and Cox regression analyses. Results: A total of 185 patients [119 men, median age 65 years, median ECOG performance status (PS) 1] were identified. One hundred and sixty-eight patients had extensive disease (ED) at the time of paclitaxel therapy. Paclitaxel was mainly given as third- or fourth-line therapy (93%). The response rate (RR) was 17% and disease control rate (DCR) 28%. Patients reached a median progression-free survival (PFS) of 1.6 (95% CI: 1.4-1.8) months and median overall survival (OS) of 3.3 (95% CI: 2.8-3.9) months. Main toxicities were fatigue (25%) and polyneuropathy (17%). Dose reduction of >/=25% was associated with shorter PFS [1.9 (95% CI: 1.5-2.3) vs. 1.4 (95% CI: 1.3-1.5) months; P=0.004]. Further independent predictive factors for PFS were gender, age, and hepatic/brain metastases (P<0.05). Tumor response to paclitaxel, PS, number and location of metastases, dose reduction, and smoking history were significant factors for OS in univariable analyses (P<0.05), while PS, dose reduction, status of cerebral/hepatic metastases, tumor response, and smoking history were retained as independent prognostic factors in multivariable testing. Notably, ECOG PS 2 patients had toxicity rates similar to ECOG PS 0-1 patients (63% vs. 62%), as well as a comparable DCR (29% vs. 28%), which was associated with prolonged survival (4.5 vs. 3.2 months for refractory cases, P=0.034). Conclusions: Paclitaxel has clinically relevant activity in heavily pretreated SCLC. While patients with good PS and no cerebral/hepatic metastases derive the greatest benefit, ECOG PS 2 per se should not be used as a criterion to exclude patients.
- von Eiff, D.
- Bozorgmehr, F.
- Chung, I.
- Bernhardt, D.
- Rieken, S.
- Liersch, S.
- Muley, T.
- Kobinger, S.
- Thomas, M.
- Christopoulos, P.
- Steins, M.
Keywords
- Small cell lung cancer (SCLC)
- paclitaxel
- progressive disease (PD)
- of Thoracic Disease from Dec 2018 to Nov 2020. The authors report the following
- relevant financial activities unrelated to the submitted work: F Bozorgmehr has
- received research funding from BMS, Astra Zeneca and honoraria from Novartis,
- MSD. S Rieken reports honoraria and travel expenses from Elekta Inc., Accuray
- Inc., AstraZeneca, BMS, Lilly, Roche, DGP, DKG, Degro
- IITs and other research
- funding from BMS, Accuray Inc., Merck KGaA
- Consulting or advisory role: Accuray
- Inc., AstraZeneca GmbH. S Liersch reports advisory board honoraria from BMS,
- Amgen, MSD and speaker's honoraria from MSD, Sanofi. T Muley reports research
- grants, travel expenses, honorarium for report and patent applications from Roche
- and research grants from Chugai Pharma. M Thomas reports advisory board honoraria
- from AbbVie, BMS, Boehringer, Celgene, Lilly, MSD, Novartis, Roche, Takeda
- speaker's honoraria from Lilly, MSD, Takeda
- research funding from AstraZeneca,
- BMS, Celgene, Roche and travel grants from BMS, Boehringer, MSD, Novartis. PC
- reports lecture fees from Roche, Chugai and Novartis. The other authors have no
- conflicts of interest to declare.
