Our study found that IP produced less grade 3/4 hematological toxicity but more grade 3/4 diarrhea than EP. The incidence of 3/4 grade neutropenia when using EP as first-line treatment was significantly higher than when using IP (56% in group B versus 29% in group B, P=0.015), and the incidence of 3/4 grade diarrhea was significantly lower when using EP than when using IP (33% in group A versus 16% in group B, P=0.012); 3/4 grade neutropenia occurred significantly more often in patients receiving IP as second-line treatment than in those receiving IP as first-line therapy, whereas the incidence of 3/4 grade hematological and non-hematological toxicity was similar in those receiving EP as first-line or second-line treatment. Although the overall PFS was similar between the two groups, group A showed a slight advantage compared with group B. Therefore, the IP regimen may be an alternative to the EP regimen in first-line treatment of E-SCLC. In terms of side effects, it is suggested that the toxicity of IP as a first-line treatment is less, and that a protocol of IP followed by EP is the preferred sequential program.

In summary, the short-term and long-term effects of these two sequential treatments for E-SCLC is similar, but the toxicity of IP as first-line treatment is less. However, considering adverse events and patient compliance, irinotecan should be used cautiously in patients carrying abnormal UGT1A1 gene polymorphism. But only consider the first-line treatment of E-SCLC IP remains an appropriate choice. Large, randomized, double-blind, prospective studies are still necessary.

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The authors report no conflicts of interest in this work.

Xiaoguang Xiao, Shujing Wang, Shu Xia, Man Zou, Yang Li, Yao Wei, Qi Mei, Yuan Chen

Department of Oncology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, People’s Republic of China   


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