Outcomes of second-line chemotherapy in patients with relapsed extensive small cell lung cancer.

Introduction: Extensive-disease small cell lung cancer (ED SCLC) is characterized by initial chemosensitivity, followed inevitably by relapse. The optimal role of additional chemotherapy at the time of progression is controversial. We reviewed the experience of all patients over a 5-year period with ED SCLC to describe outcomes of second-line chemotherapy.

Methods: Records of all patients registered at The Ottawa Hospital Regional Cancer Centre with ED SCLC were reviewed, and baseline prognostic factors, chemotherapy delivered, and treatment outcomes were extracted. Multivariate analyses were performed to determine the effect of second-line chemotherapy on survival.

Results: Of 192 patients who completed first-line chemotherapy, only 62 (32%) received second-line therapy; these patients were younger and fitter, and lived longer from the time of relapse (5.2 vs. 1.5 months). Second-line therapy was an independent predictor of survival. Benefit was observed in patients with relapse either before or after 60 days from the completion of first-line therapy.

Conclusions: Second-line chemotherapy given at the time of relapse of ED SCLC seems to be associated with prolongation of survival, even in patients traditionally felt to have chemoresistant disease. The majority of patients, however, do not receive second-line therapy because of poor clinical status at relapse.