Platinum-Doublet Chemo Shows Efficacy as a Second-Line Treatment for Relapsed SCLC

Results from a systemic review and meta-analysis found patients with relapsed small-cell lung cancer (SCLC) responded well to second-line, platinum-doublet chemotherapy (Lung Cancer. 2021 Apr 19;156:59-67.).

“Optimal second-line chemotherapy for patients with relapsed small-cell lung cancer remains debatable. In addition to topotecan or amrubicin monotherapy, re-challenge with first-line platinum-doublets have been commonly used,” explained Kohei Horiuchi, Division of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan. 

Using PubMed and EMBASE, researchers identified studies that included patients with relapsed small-cell lung cancer and compared second-line platinum-doublets with non-platinum-based regimens.

The relative risk of objective response rate (ORR) and disease control rate of the second-line chemotherapy were calculated through a meta-analysis. Additionally, researchers conducted subgroup analyses to compare standard second-line regimens and sensitive relapse. Meanwhile, progression-free survival (PFS), overall survival (OS), and adverse events (AEs) were systematically reviewed.

The analysis included a total of 1,222 patients across ten studies published between 2011 and 2020. Of the total patients, 438 received platinum-doublets, and 748 received non-platinum-based regimens.

The ORR was 47.3% (95 % CI: 40.5-54.0) in the second-line platinum-doublet group and 31.5 % (95 % CI: 22.2-40.8) amongst those given non-platinum regimens. Additionally, patients treated with platinum-doublets also had significantly higher disease control rates (RR [95 % CI]: 1.152 [1.052-1.262], P = 0.002). 

A subgroup analysis comparing platinum-doublets with topotecan or amrubicin found that patients treated with platinum-doublets had a significantly higher ORR and disease control rate (RR [95 % CI]: 1.663 [1.055-2.619], P = 0.028 and 1.170 [1.021-1.340], P = 0.023 respectively). 

When compared with monotherapies, platinum-doublet treatment-related AE’s were acceptable. Both PFS and OS were consistent with tumor responses.

“Platinum-doublet chemotherapy as second-line treatment for patients with relapsed small-cell lung cancer can be considered as a reasonable option in comparison with non-platinum regimens,” concluded Dr Horiuchi et al. —Alexandra Graziano