Irinotecan and etoposide have demonstrated improvement in survival when combined with cisplatin in first-line and second-line therapy. As we have discussed above, these two drugs may be only effective but difficult to choose in clinical. EP and IP are both effective regimens in the treatment of SCLC, but limited information is available concerning their optimal sequential order. In this retrospective study, we compared the efficacy and safety of IP and EP when used as first-line therapy in E-SCLC, and given the tendency of SCLC to relapse, we also attempted to identify the optimal sequence of IP and EP when treating patients with the disease.


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METHODS AND MATERIALS

Patient characteristics

In this study, follow-up data were analyzed for 93 patients treated for E-SCLC in the oncology department at Tongji Hospital between January 2011 and November 2013. Histopathological specimens was obtained by fiberoptic bronchoscopy, computed tomography (CT)-guided transthoracic needle aspiration, or cervical lymph node biopsy. The pathological diagnosis of SCLC was reviewed and confirmed by two separate pathologists using the Veterans Administration Lung Study Group staging system to identify E-SCLC.

The study inclusion criteria were Eastern Cooperative Oncology Group score 0 to 2; essentially normal routine blood, liver and kidney function tests before treatment; assessable disease; and written informed consent. The patients were assigned to receive IP until progression and then EP (group A) or the reverse treatment sequence (group B, Table 1).

The study was approved by the medical ethics committee of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology. All patients enrolled in this study provided written informed consent.

Chemotherapy

IP consisted of irinotecan (60 mg/m2 intravenously on days 1, 8, and 15) and cisplatin (75 mg/m2intravenously on days 1) every 4 weeks. EP consisted of etoposide (100 mg/m2 on days 1–3) and cisplatin (75 mg/m2 intravenously on day 1) every 3 weeks. Antiemetic prophylaxis with a 5-hydroxytryptamine 3-receptor antagonist was administered routinely. The dose of cisplatin could be divided into three days use depending on the patient’s performance status and their ability to tolerate chemotherapy. The doses of irinotecan, etoposide, and cisplatin could be adjusted according to the severity of adverse events.

Follow-up visits

A physical examination, full blood count, and hepatic and renal function tests were performed before each cycle of chemotherapy. Measurable lesions were evaluated at baseline by CT scan. A CT scan was repeated for every two cycles of chemotherapy or adjusted according to illness.

After 3 months of systemic therapy, each patient underwent a contrast-enhanced CT scan of the chest or an ultrasound B mode or CT scan of the upper abdomen. All patients were provided with information on smoking cessation at the time of diagnosis. Follow-up was performed in hospital, in the outpatient clinic, and by telephone or email. Dates of first and second occurrence of tumor progression were recorded.