New state of the art in small-cell lung cancer.

Chemotherapy is currently the main treatment for all stages of small-cell lung cancer. In extensive disease, etoposide/cisplatin (Platinol) is standard treatment, and in limited disease, etoposide/cisplatin with early concurrent thoracic radiotherapy twice daily is a typical regimen. Therapeutic outcomes, however, leave substantial room for improvement. The topoisomerase I inhibitor irinotecan (Camptosar, CPT-11) is one of the most active agents against small-cell lung cancer. In a phase II study, irinotecan yielded response rates of 33% to 50%, depending on prior treatment status. Combinations with cisplatin have resulted in a median survival of 14.3 months in patients with limited disease and 13.0 months in extensive disease. A phase III study in extensive-disease small-cell lung cancer compared irinotecan/cisplatin and standard etoposide/cisplatin regimens, and demonstrated a significant difference in survival in the irinotecan-containing arm (411 vs 282 days). Planned phase III studies in North America will confirm and extend these results. Based on these promising data, irinotecan/cisplatin regimens represent a new standard treatment for extensive-disease small-cell lung cancer.