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LUNG CANCER: SMALL-CELL
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Regimen/Number Of Patients |
Drug Dose and Route |
Leukopenia/ Neutropenia Toxicity |
Anemia Toxicity |
Other Grade III-IV Toxicities |
Emetogenic Potential |
Consequences of Adverse Event(s) |
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CAV (VAC) (Fukuoka M, et al, J Natl Cancer Inst. 1991;83:855-61)
N= 97
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Cyclophosphamide 800 mg/m2 IV-day 1 Doxorubicin 50 mg/m2 IV day 1 Vincristine 1.4 mg/m2 (maximum 2 mg) IV day 1 Repeat cycle every 21-28 days |
Leukopenia Grade III 42% Grade IV 36 %
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Nausea/Vomiting (Grade II-IV ) 64% Thrombocytopenia 13% Neuropathy (Grade II-IV) 9% Hepatic (Grade II-IV) 11% Renal (Grade II-IV) 4% Alopecia (Grade II-IV) 72% |
Day 1 Level 5 |
Toxic mortality 3 %
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EC ( Kosmidis PA, et al, Semin Oncol, 1994;21:23-30)
N= 72 |
Etoposide 100 mg/m2/d IV days 1-3 Carboplatin 300 mg/m2 IV days 1 Repeat cycle every 21 days |
Leukopenia Grade III 10 % Grade IV 7 %
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Neutropenic Infection (all grades ) 11 % Thrombocytopenia (Grade IV) 4 % Alopecia (Grade III) 7 %
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Day 1 Level 5 Days 2, 3- Level |
Delivered dose intensity 80 % for carbo and 81 % for etoposide Treatment delay 3 % |
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EP ( Pujol JL, et al. J Natl Cancer Inst. 2001;93:300-08)
N= 109
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Etoposide 100 mg/m2/d IV days 1 3 Cisplatin 100 mg/m2 IV day 2 Repeat cycle every 28 days |
Neutropenia Grade III-IV 85%
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Grade III-IV 18% |
Documented Infections (all grades ) 8 % Fever (all grades) 18 % Nausea/Vomiting 19 % Thrombocytopenia 18 % Creatinine Increase 12 % Bilirubin Increase 2 %
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Days 1, 3 Level 2 Day 2 Level |
RBC transfusions 13 % Platelet transfusions 5 % Antibiotic infusions 26% Toxic death 5.5 % Early termination of therapy due to toxicity 5% |
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Irinotecan-Cisplatin (Noda K, et al, N Engl J Med. 2002;346:85-91)
N= 75 |
Irinotecan 60 mg/m2 days 1, 8, 15 Cisplatin 60 mg/m2 on day 1 only Repeat cycle every 28 days X 4 cycles |
JCOG Criteria : Neutropenia Grade III 40 % Grade IV 25.3 %
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Grade III 26.7% |
Fever (Grade III 1.3% Infection 5.3 % Thrombocytopenia 5.3 % Diarrhea 16 % Nausea/Vomiting (Grade III) 13.3% Decreased Arterial Oxygen Pressure 5 % Abnormal Liver Enzymes (Grade III ) 4 % |
Day 1 Level 5 Days 8, 15- level II |
There were 3 treatmet related deaths (bleeding, neutropenia/diarrhea, and pneumonia ) |
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PCDE (Pujol JL, et al, J Natl Cancer Inst. 2001;93:300-08)
N= 117
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Etoposide 100 mg/m2/d IV days 1 -3 Cisplatin 100 mg/m2/d IV day 2 Cyclophosphamide 400 mg/m2/d IV days 1 -3 Epirubicin 40 mg/m2 IV day 1 Repeat cycle every 28 days |
Neutropenia Grade III- IV 99%
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Grade III-IV 51 % |
Documented Infections (all grades ) 22 % Fever (all grades ) 70 % Nausea / Vomiting 22 % Thrombocytopenia 78 % Creatinine Increase 6 % Bilirubin Increase 1 % |
Days 1 2- Level 5 Day 3 Level 4 |
RBC transfusions 45% Platelet transfusions 38% Antibiotic infusions 67 % Cardiac toxic death 8 % Early termination of therapy due to toxicity 15 % |
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LUNG CANCER : SMALL-CELL (continued ) : Page 2
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Regimen/Number Of Patients |
Drug Dose and Route |
Leukopenia/ Neutropenia Toxicity |
Anemia Toxicity |
Other Grade III-IV Toxicities |
Emetogenic Potential |
Consequences of Adverse Event(s) |
|
Topotecan (von Pawel J, et al. J Clin Oncol. 1999;17:658-67)
N= 107
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Topotecan 1.5 mg/m2/d IV over 30 minutes days 1 5 Repeat cycle every 21 days |
Leukopenia Grade III 54.8% Grade IV 31.7% Neutropenia Grade III 18.3% Grade IV 70.2%
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Level III 39.4 % Level IV 2.9 % |
Neutropenic Fever 28 % Neutropenic Sepsis 5 % Thrombocytopenia 58 % Nausea 4 % Fatigue 5 % Vomiting 2 % Stomatitis 2 % Anorexia 1 % Diarrhea 1 % Fever 2 % |
Days 1 5 Level 2 |
Infectious mortality 4% Treatment discontinued due to toxicity in 9 % of patients RBC transfusions 52% Dose intensity 76% Treatment detay 1 week 7 % Platelet transfusions in 19.6 % of patients Treatment related mortality : 1 patient acute respiratory insufficiency, 1 patient intracerebral bleeding
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Topotecan-Paclitaxel (Jacobs SA, et al, Proc Am Soc Clin Oncol, 1999;18:470a. Abstract 1814)
N= 29
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Topotecan 1 mg/m2/d IV days 1-5 Paclitaxel 135 mg/m2 IV over 24 hr day 5 Repeat cycle every 28 days Primary prophylaxis with G-CSF Appropriate premedications listed in Section 2, Commonly Used Premedicaiton Regimens |
Grade IV 96%
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Neutropenic Fever % of cycles Thrombocytopenia (Grade IV 0 18% of cycles Allergic Reaction * 7 % Cardiac Dysrhythmia * 3%
Grade unknown
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Days 1 4 Level 2 Day 5 Level 3 |
Septic death 3 % |