Evans W K, Radwi A, Tomiak E, Logan D M, Martins H, Stewart D J, Goss G, Maroun J A, Dahrouge S
University of Ottawa, Ontario, Canada.
Am J Clin Oncol. 1995 Apr;18(2):149-55.
Elderly patients with small cell lung cancer (SCLC) and/or those with comorbid conditions are frequently not considered candidates for standard combination chemotherapy. An active, but less toxic regimen is needed for this group of patients.
Forty-seven elderly (> 65 years) or medically unfit patients with SCLC were treated with oral etoposide 100 mg/m2 x 7 days and carboplatin 150 mg/m2 day 1. Treatment was given every 3-4 weeks for six cycles in responding patients. Patients responding to the chemotherapy regimen were also treated with prophylactic cranial irradiation, and limited-stage patients received thoracic radiotherapy. The study population included 36 extensive-stage patients and 11 limited-disease patients with renal or cardiac disease that precluded standard chemotherapy. The median age of the study population was 69 years (range: 47-84).
Nine of 47 patients were inevaluable for response, including four patients who succumbed to sepsis. Of the 38 patients evaluable for response, 71% responded (95% CI: 56-86%) (88% LD; 67% ED) with a complete response in 29% of patients (50% LD; 23% ED). Based on an analysis of intent to treat, the overall response rate was 60% and the median survival time of the whole group was 46 weeks (LD, 59 weeks; ED, 45 weeks). Treatment was generally well tolerated. Neutropenia was the dose-limiting toxicity; the median nadir granulocyte count was 1.04 x 10(9)/L (range: 0-8.2).
We conclude that this regimen can provide palliation to SCLC patients who might not otherwise be considered for systemic chemotherapy.
老年小细胞肺癌（SCLC）患者和/或合并其他疾病的患者通常不被视为标准联合化疗的候选对象。这组患者需要一种有效但毒性较小的治疗方案。
47例老年（>65岁）或身体状况不佳的SCLC患者接受口服依托泊苷100mg/m²，连用7天，第1天给予卡铂150mg/m²治疗。对有反应的患者每3 - 4周进行一次治疗，共六个周期。对化疗方案有反应的患者还接受了预防性颅脑照射，局限期患者接受了胸部放疗。研究人群包括36例广泛期患者和11例因肾脏或心脏疾病而不能接受标准化疗的局限期患者。研究人群的中位年龄为69岁（范围：47 - 84岁）。
47例患者中有9例无法评估反应，其中4例死于败血症。在可评估反应的38例患者中，71%有反应（95%置信区间：56 - 86%）（局限期88%；广泛期67%），29%的患者完全缓解（局限期50%；广泛期23%）。基于意向性分析，总体缓解率为60%，全组中位生存时间为46周（局限期，59周；广泛期，45周）。治疗一般耐受性良好。中性粒细胞减少是剂量限制性毒性；中位最低点粒细胞计数为1.04×10⁹/L（范围：0 - 8.2）。
我们得出结论，该方案可为那些可能无法接受全身化疗的SCLC患者提供姑息治疗。
