08:29
Sawyer M.D.
This study investigated whether chemotherapy with etoposide and cisplatin was superior to cyclophosphamide epirubicin and vincristine in small cell lung cancer. The CEV regimen was chosen instead of CAV because epirubicin was regarded as being less cardiotoxic than doxorubicin. THis study was conducted in Norway between 1989 and 1994 and recruited 440 consecutive patients from 25 hospitals. In total , 436 of these patients were eligible and were randomized to each arm. Patients were stratified according to the extent of disease.
EP chemotherapy consisted of five courses of eoposide 100mg intravenously and cispaltin 75mg on day 1 , followed by oral etoposide 200mg daily on days 2 to 4. The CEV group received five courses of cyclophosphamide 1000mg epirubicin 50mg and cincristine 2mg all on day 1 . Chemothrapy was administered every 3 weeks in both arms. In addition, patients with limited disease received thoracic radiotherapy concurrent with third cycle of chemotherapy. Prophylactic cranial irradiation was given to all patients with limited disease who had achieved a complete response when restaged 4 weeks after chemotherapy increases the relevance of this study as subsequent metaanalyses have shown a survival benefit for each individual treatment. Both are now considered standard therapy although the timing and dosing of thoracic radiotherapy is still under investigation.
The 2 and 5 year survival rates in EP arm were significantly higher than compared to the CEV arm . Median survival was also significantly improved in the EP arm. Further analysis showed that EP was only superior to CEV in patients with limited disease. Mediansurvival was 14.5 monthsfor EP arm compared with 8% and 3% in the CEV arm. A trend towards improved survival was senn amongst patients with extensive disease treated with EP rather than CEV.
This study shows a clear superiority for the EP regimen over CEV in patient with limited disease SCLC. These results have been confirmed in three recent meta-analyses. In particular Chutelk reviewed all patients treated at National Cancer Institute from 1973 to1993 and showed a modest survival benefit in LD patients who received cisplatin-based chemotherapy. For patients with limited disease SCLC, EP should be the standard treatment.
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