Correspondence

Initial Chemotherapeutic Doses and Long-Term Survival in Limited Small-Cell Lung Cancer

N Engl J Med 2001; 345:1281-1282October 25, 2001

Article

To the Editor:

We previously reported that in a multicenter, randomized trial that involved 105 patients with limited small-cell lung cancer, higher initial doses of cyclophosphamide and cisplatin improved overall survival.1 The study was stopped early at the recommendation of an independent data-monitoring committee, and the median duration of follow-up at the time of publication was 33 months.2 To evaluate whether these findings persisted over the long term, we reevaluated the patients after a median follow-up period of 11 years.

The updated overall survival rates for patients who received higher initial doses of cisplatin (100 mg per square meter of body-surface area) and cyclophosphamide (300 mg per square meter daily for four days) and for those who received lower initial doses (cisplatin, 80 mg per square meter; cyclophosphamide, 225 mg per square meter daily for four days) are shown in Figure 1Figure 1Overall Survival among Patients with Limited Small-Cell Lung Cancer, According to Treatment (Higher vs. Lower Initial Doses of Chemotherapy).. The two- and five-year survival rates were 42 percent and 26 percent, respectively, in the higher-dose group, and 20 percent and 8 percent, respectively, in the lower-dose group. The relative risk of death among those who received higher initial doses of chemotherapy, as compared with those who received lower doses, was 0.63 (95 percent confidence interval, 0.42 to 0.96). The results were similar when the analyses were stratified according to center.

These results are consistent with previously published findings and demonstrate that moderate increases in the initial doses of drugs may lead to a significant improvement in long-term survival among patients with limited small-cell lung cancer.

Rodrigo Arriagada, M.D.
Jean-Pierre Pignon, M.D., Ph.D.
Thierry Le Chevalier, M.D.
Institut Gustave-Roussy, 94805 Villejuif CEDEX, France
gocchi@ctcinternet.cl

2 References

1. 1

   Arriagada R, Le Chevalier T, Pignon J-P, et al. Initial chemotherapeutic doses and survival in patients with limited small-cell lung cancer. N Engl J Med 1993;329:1848-1852
   Full Text | Web of Science | Medline

2. 2

   Pignon JP, Tarayre M, Auquier A, et al. Triangular test and randomized trials: practical problems in a small cell lung cancer trial. Stat Med 1994;13:1415-1421
   CrossRef | Web of Science | Medline

Citing Articles (6)

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   David Planchard, Cécile Le Péchoux. (2011) Small cell lung cancer: new clinical recommendations and current status of biomarker assessment. European Journal of Cancer 47, S272-S283
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   Cécile Le Péchoux, Ariane Dunant, Suresh Senan, Aaron Wolfson, Elisabeth Quoix, Corinne Faivre-Finn, Tudor Ciuleanu, Rodrigo Arriagada, Richard Jones, Rinus Wanders, Delphine Lerouge, Agnès Laplanche. (2009) Standard-dose versus higher-dose prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer in complete remission after chemotherapy and thoracic radiotherapy (PCI 99-01, EORTC 22003-08004, RTOG 0212, and IFCT 99-01): a randomised clinical trial. The Lancet Oncology 10:5, 467-474
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   Sanjay Popat, Mary O??Brien. (2005) Chemotherapy strategies in the treatment of small cell lung cancer. Anti-Cancer Drugs 16:4, 361-372
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   L. Iglesias Pérez. (2005) Carcinoma de pulmón de células pequeñas. Medicine - Programa de Formación Médica Continuada Acreditado 9:24, 1563-1573
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   Joe Feinglass, Jared R Adams, Benjamin Djubegovic, Charles L Bennett, Gary H Lyman. (2002) G-CSF as prophylaxis of febrile neutropenia in SCLC. Expert Opinion on Pharmacotherapy 3:9, 1273-1281
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   Douglas B. Flieder. (2002) Neuroendocrine tumors of the lung: recent developments in histopathology. Current Opinion in Pulmonary Medicine 8:4, 275-280
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