Medical Oncology

, 35:61 | Cite as

Rechallenge treatment with a platinum-based regimen in patients with sensitive relapsed small-cell lung cancer

  • Yoshiko Naito
  • Kazuhiko Yamada
  • Yohei Imamura
  • Hidenobu Ishii
  • Norikazu Matsuo
  • Takaaki Tokito
  • Takashi Kinoshita
  • Koichi Azuma
  • Tomoaki Hoshino
Original Paper


Among patients with relapsed small-cell lung cancer (SCLC), those who relapse > 90 days after first-line chemotherapy are classified sensitive relapse. Rechallenge with a first-line platinum-based regimen has been used in sensitive relapsed SCLC patients, but its importance is not known. We evaluated the outcome of rechallenge with platinum-based chemotherapy for sensitive relapse patients. We reviewed consecutive patients with sensitive relapsed SCLC who received second-line chemotherapy between January 1999 and December 2016. We evaluated the treatment outcomes of platinum-based rechallenge and non-rechallenge regimens for second-line chemotherapy in sensitive relapse patients. Of 245 patients, 81 sensitive relapse patients received second-line chemotherapy. Sixty-seven patients (82.7%) were treated with rechallenging platinum-based regimens (“rechallenge group”) and 14 patients (17.3%) were treated with other regimens (“non-rechallenge group”) as second-line chemotherapy. Median progression-free survival (PFS) was 5.1 months in the rechallenge group and 3.5 months in the non-rechallenge group, and median survival time was 10.8 and 8.2 months, respectively. There were no significant differences in PFS or overall survival (OS) between the two groups. Sub-analyses of patients who received chemotherapy alone as first-line treatment showed that the rechallenge group had longer PFS than that of the non-rechallenge group (median 5.4 vs. 3.6 months, p = 0.0038), and the rechallenge group had a tendency to have longer OS than non-rechallenge group. These data suggest that rechallenge treatment with a platinum-based regimen could be second-line chemotherapy in patients with sensitive relapsed SCLC, especially those treated with chemotherapy alone as first-line therapy.


Small-cell lung cancer Sensitive relapse Rechallenge chemotherapy Second-line chemotherapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval and consent to participate

Institutional review board (IRB) approval from the ethical committee of the Kurume University Hospital was obtained for this study (Ref 14038). As this study was retrospective, informed consent was waived by the IRB.


  1. 1.
    Jackman DM, Johnson BE. Small-cell lung cancer. Lancet. 2005;366:1385–96.CrossRefPubMedGoogle Scholar
  2. 2.
    Van Meerbeeck JP, Fennell DA, De Ruysscher DK. Small-cell lung cancer. Lancet. 2011;378:1741–55.CrossRefPubMedGoogle Scholar
  3. 3.
    Gustafsson BI, Kidd M, Chan A, et al. Bronchopulmonary neuroendocrine tumors. Cancer. 2008;113:5–21.CrossRefPubMedGoogle Scholar
  4. 4.
    Postmus PE, Smit EF. Treatment of relapsed small cell lung cancer. Semin Oncol. 2001;28:48–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Ardizzoni A, Hansen H, Dombernowsky P, et al. Topotecan, a new active drug in the second-line treatment of small-cell lung cancer: a phase II study in patients with refractory and sensitive disease. The European Organization for Research and Treatment of Cancer Early Clinical Studies Group and New Drug Development Office, and the Lung Cancer Cooperative Group. J Clin Oncol. 1997;15:2090–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Kim YH, Goto K, Yoh K, et al. Performance status and sensitivity to first-line chemotherapy are significant prognostic factors in patients with recurrent small cell lung cancer receiving second-line chemotherapy. Cancer. 2008;113:2518–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Giaccone G, Donadio M, Bonardi G, et al. Teniposide in the treatment of small-cell lung cancer: the influence of prior chemotherapy. J Clin Oncol. 1988;6:1264–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Eckardt JR, von Pawel J, Pujol JL, et al. Phase III study of oral compared with intravenous topotecan as second-line therapy in small-cell lung cancer. J Clin Oncol. 2007;25:2086–92.CrossRefPubMedGoogle Scholar
  9. 9.
    von Pawel J, Gatzemeier U, Pujol JL, et al. Phase II comparator study of oral versus intravenous topotecan in patients with chemosensitive small-cell lung cancer. J Clin Oncol. 2001;19:1743–9.CrossRefGoogle Scholar
  10. 10.
    Antonio R. Relapsed small-cell lung cancer: platinum re-challenge or not. J Thorac Dis. 2016;8:2360–4.CrossRefGoogle Scholar
  11. 11.
    Postmus PE, Berendsen HH, van Zandwijk N, et al. Retreatment with the induction regimen in small cell lung cancer relapsing after an initial response to short term chemotherapy. Eur J Cancer Clin Oncol. 1987;23:1409–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Giaccone G, Ferrati P, Donadio M, et al. Reinduction chemotherapy in small cell lung cancer. Eur J Cancer Clin Oncol. 1987;23:1697–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Brahmer Julie R, Ettinger David S. The role of topotecan in the treatment of small cell lung cancer. Oncologist. 1998;3:11–4.PubMedGoogle Scholar
  14. 14.
    O’Brien ME, Ciuleanu TE, Tsekov H, et al. Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol. 2006;24(5441–7):1.Google Scholar
  15. 15.
    Johnson DH, Greco FA, Strupp J, et al. Prolonged administration of oral etoposide in patients with relapsed or refractory small-cell lung cancer: a phase II trial. J Clin Oncol. 1990;8:1613–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Masuda N, Fukuoka M, Kusunoki Y, et al. CPT-11: a new derivative of camptothecin for the treatment of refractory or relapsed small-cell lung cancer. J Clin Oncol. 1992;10:1225–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Inoue A, Sugawara S, Yamazaki K, et al. Randomized phase II trial comparing amrubicin with topotecan in patients with previously treated small-cell lung cancer: North Japan Lung Cancer Study Group Trial 0402. J Clin Oncol. 2008;20(26):5401–6.CrossRefGoogle Scholar
  18. 18.
    Jotte R, Conkling P, Reynolds C, et al. Randomized phase II trial of single-agent amrubicin or topotecan as second-line treatment in patients with small-cell lung cancer sensitive to first-line platinum-based chemotherapy. J Clin Oncol. 2011;20(29):287–93.CrossRefGoogle Scholar
  19. 19.
    Inoue A, Sugawara S, Maemondo M, et al. Randomized phase II trial comparing amrubicin with re-challenge of platinum doublet in patients with sensitive-relapsed small-cell lung cancer: North Japan Lung Cancer Study Group trial 0702. Lung Cancer. 2015;89:61–5.CrossRefPubMedGoogle Scholar
  20. 20.
    von Pawel J, Jotte R, Spigel DR, et al. Randomized phase III trial of amrubicin versus topotecan as second-line treatment for patients with small-cell lung cancer. J Clin Oncol. 2014;10(32):4012–9.CrossRefGoogle Scholar
  21. 21.
    Goto K, Ohe Y, Shibata T, et al. Combined chemotherapy with cisplatin, etoposide, and irinotecan versus topotecan alone as second-line treatment for patients with sensitive relapsed small-cell lung cancer (JCOG0605): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2016;17:1147–57.CrossRefPubMedGoogle Scholar
  22. 22.
    Korkmaz T, Seber S, Kefeli U, et al. Comparison of second-line treatment outcomes between sensitive and refractory small cell lung cancer patients: a retrospective analysis. Clin Transl Oncol. 2013;15:535–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Garassino MC, Torri V, Michetti G, et al. Outcomes of small-cell lung cancer patients treated with second-line chemotherapy: a multi-institutional retrospective analysis. Lung Cancer. 2011;72:378–83.CrossRefPubMedGoogle Scholar
  24. 24.
    Wakuda K, Kenmotsu H, Naito T, et al. Efficacy of rechallenge chemotherapy in patients with sensitive relapsed small cell lung cancer. Am J Clin Oncol. 2015;38:23–32.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Respirology, Neurology, and Rheumatology, Department of Internal MedicineKurume University School of MedicineKurumeJapan

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