Johnson D H, Greco F A, Strupp J, Hande K R, Hainsworth J D
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
J Clin Oncol. 1990 Oct;8(10):1613-7. doi: 10.1200/JCO.1990.8.10.1613.
Twenty-two patients with recurrent small-cell lung cancer (SCLC) were treated with single-agent etoposide 50 mg/m2/d by mouth for 21 consecutive days. Eleven patients had received previous chemotherapy with cyclophosphamide, doxorubicin, and vincristine (CAV) or etoposide (CAE) or both (CAVE). Four of the latter patients also received salvage treatment with cisplatin and etoposide (EP). Nine patients had been treated with EP as induction therapy, while two patients had received high-dose cyclophosphamide, etoposide and cisplatin (HDCEP). Altogether, 18 patients had received previous intravenous etoposide. The median time off chemotherapy was 4.5 months (range, 1 to 28.9 months). Ten patients (45.5%; 95% confidence interval [CI], 27% to 65%) achieved a complete or partial response. Responses were most common in patients who had responded to previous chemotherapy and who had not received any treatment in the 90 days before initiation of oral etoposide. Median response duration was 4 months (range, 1.5 to 9.5 months) and median survival was 3.5+ months (range, 1.0 to 15+ months). Leukocyte and platelet nadirs were 1,800/microL and 160,000/microL, respectively, during cycle 1 of treatment and occurred between days 21 and 28. Overall, total leukocyte count decreased to less than 1,000/microL during 10 of 56 cycles (18%). Five patients required six hospitalizations for neutropenia and fever. There were two toxic deaths due to sepsis. Platelet counts less than 50,000/microL occurred in 14 cycles (25%). Alopecia developed in all patients; gastrointestinal toxicity was uncommon. This schedule of etoposide administration warrants further study in combination with other active agents in previously untreated patients with SCLC.
22例复发性小细胞肺癌（SCLC）患者接受了单药依托泊苷治疗，剂量为50mg/m²/d，口服，连续21天。11例患者先前接受过环磷酰胺、阿霉素和长春新碱（CAV）或依托泊苷（CAE）或两者联合（CAVE）的化疗。后一组患者中有4例还接受了顺铂和依托泊苷（EP）的挽救治疗。9例患者接受过EP诱导治疗，2例患者接受过高剂量环磷酰胺、依托泊苷和顺铂（HDCEP）治疗。总共有18例患者先前接受过静脉注射依托泊苷治疗。化疗中断的中位时间为4.5个月（范围1至28.9个月）。10例患者（45.5%；95%置信区间[CI]，27%至65%）达到完全或部分缓解。缓解在先前对化疗有反应且在开始口服依托泊苷前90天内未接受任何治疗的患者中最为常见。中位缓解持续时间为4个月（范围1.5至9.5个月），中位生存期为3.5 +个月（范围1.0至15 +个月）。在治疗的第1周期，白细胞和血小板最低点分别为1800/μL和160,000/μL，发生在第21至28天之间。总体而言，在56个周期中的10个周期（18%）白细胞总数降至低于1000/μL。5例患者因中性粒细胞减少和发热需要住院6次。有2例因败血症导致的毒性死亡病例。血小板计数低于50,000/μL发生在14个周期（25%）。所有患者均出现脱发；胃肠道毒性不常见。这种依托泊苷给药方案值得在先前未治疗的SCLC患者中与其他活性药物联合进行进一步研究。
