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Lung Cancer |

A Case of Good Response to Oral Etoposide in Extensive Disease Small Cell Lung Cancer With Poor Performance Status

Jung Ar Shin, MD; Sang Young Kim*, MD; Min Kwang Byun, MD; Yoon Soo Chang, MD; Hung Jung Kim, MD; Chul Min Ahn, MD
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Yonsei University College of Medicine, Seoul, Republic of Korea


Chest. 2012;142(4_MeetingAbstracts):612A. doi:10.1378/chest.1390738
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Abstract

SESSION TYPE: Cancer Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 01:30 PM

INTRODUCTION: We present a case of extensive disease (ED) small cell lung cancer (SCLC) treated with oral etoposide monotherapy in an elderly patient with poor performance status, showing good overall survival and less side effects.

CASE PRESENTATION: A 82-year-old male was diagnosed small cell lung cancer (SCLC) with spinal metastasis (extensive disease (ED)). He was also diagnosed reactivation of pulmonary tuberculosis with sputum Mycobacterial culture. The patient and his family refused intravenous chemotherapy, because of worries about adverse reactions of chemotherapy due to old age and poor general condition with ECOG 3. He received oral etoposide monotherapy with anti-tuberculosis treatment. During oral etoposide chemotherapy, he has had no noted serious side-effects from etoposide such as a gastrointestinal or a hematologic side effect. Disease-free survival was maintained for 8.5 months. Chemotherapy was discontinued after progression of primary cancer with hepatic metastasis. Overall survival was 13.5 months.

DISCUSSION: The prognosis of ED SCLC is poor. Without chemotherapy, median survival is known only 4-6 weeks. With standard chemotherapy, median survival is approximately 10 months with a good performance status. Topoisomerase I inhibitor combined with cisplatin regimen (IC) showed superior median survival compared with standard therapy with etoposide and cisplatin (EC), but more frequent and severe complications such as grade 3 or 4 diarrhea were reported in IC group. Honecker et al. reported that carboplatin monotherapy could confer the same benefit as combination chemotherapy, but oral etoposide monotherapy seems to be inferior in overall survival. However, Souhami et al. reported combination therapy (EC or CAV) showed survival benefit compared with oral etoposide monotherapy for 1.1 month (5.9 months vs. 4.8 months), and showed more frequent severe side effect (20% vs. 8%). Carney et al. and Smit et al. reported approximately 9~9.5 months median survival with 71~79% response rate of oral etoposide monotherapy for ED SCLC in elderly patients older than 70 years of age.

CONCLUSIONS: Oral etoposide monotherapy still can be a good treatment option having fewer side effects and superior survival compared with the best supportive care in elderly patients with poor performance status who cannot withstand intravenous combination chemotherapy.

1) Souhami RL, Spiro SG, Rudd RM, Ruiz de Elvira MC, James LE, Gower NH et al. Five-day oral etoposide treatment for advanced small-cell lung cancer: randomized comparison with intravenous chemotherapy. J Natl Cancer Inst. (1997) 16;89(8):577-80.

DISCLOSURE: The following authors have nothing to disclose: Jung Ar Shin, Sang Young Kim, Min Kwang Byun, Yoon Soo Chang, Hung Jung Kim, Chul Min Ahn

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Yonsei University College of Medicine, Seoul, Republic of Korea

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