Irinotecan-Containing Regimen Improves Survival in Small-Cell Lung Cancer

Anew treatment for small-cell lung cancer holds promiseof dramatically improving survival for patients with the disease, said Dr. AlanSandler, director of Vanderbilt-Ingram Cancer Center’s Thoracic OncologyProgram, and leader of a large US study to further evaluate the treatment’sability to prolong survival in patients with small-cell lung cancer.

Japanese Study Results

A study conducted in Japan in 150 patients and published in a recent issue ofthe New England Journal of Medicine (346:85-91, 2002) found that treatment withirinotecan (CPT-11, Camptosar) and cisplatin was superior to standard therapywith cisplatin and etoposide. Patients receiving the irinotecan combination hada 55% improvement in 1-year survival and a 40% reduction in the risk of death,compared to patients being treated with cisplatin and etoposide; they were alsofour times more likely to be alive at 2 years.

"Up until this study, no treatment had been identified that increasessurvival to this extent," said Dr. Sandler. "This is the first to showa dramatic difference. For the first time, I can look a patient in the eye andsay, ‘You have a greater than 50% chance of being alive in a year.’"

Phase III US Trial

The Japanese study, conducted by the Japanese Cooperative Group, began in1995 but was stopped in 1998 due to the striking difference in survival inpatients receiving irinotecan. The ongoing phase III trial in the United Statesis designed to confirm the results of the Japanese study and to ensure that USpatients have a comparable response to the drug.

Dr. Sandler is the primary national investigator for the study, which is alsobeing led by investigators at the University of Colorado, Indiana University,and Fox Chase Cancer Center in Philadelphia. Funded by Pharmacia (manufacturerof irinotecan), the study is comparing irinotecan/cisplatin with standardcisplatin/etoposide therapy. Patients will be randomized to receive one or theother therapy, with two-thirds receiving the irinotecan/cisplatin combination. Atotal of 300 patients will be enrolled in the trial nationwide.

For more information about the irinotecan trial, contact Vanderbilt-Ingram’sCancer Information Program at 1-800-811-8480.