The role of second-line chemotherapy in small cell lung cancer: a retrospective analysis

Background: To evaluate the benefit of second-line chemotherapy with platinum-based treatment in patients with recurrent small cell lung cancer (SCLC). Patients and methods: A total of 535 patients continued with follow-up or best supportive care if needed, and 229 patients who progressed after the completion of first-line chemotherapy were treated with second-line chemotherapy at the time of progression. In total, 103/229 patients received paclitaxel 190 mg/m(2) and carboplatin 5.5 area under the curve while 126/229 patients received etoposide 200 mg/m(2) and carboplatin 5.5 area under the curve every 28 days. Results: Patients administered second-line chemotherapy lived significantly longer, with a median survival of 422 days compared to 228 days in patients with best supportive care alone( P < 0.001). Patients who received paclitaxel as second-line chemotherapy lived for an-average of 462 days( 95% confidence interval: 409-514), versus 405 days in the etoposide group( 95% confidence interval: 371-438), which was not statistically significant( P= 0.086). The overall response rate was 8% for the paclitaxel group and 6% for the etoposide group. Patients with progression of the disease in more than 3 months had significantly better survival compared with those that progressed in less than 3 months( P < 0.001). Conclusion: Continuation with carboplatin/paclitaxel or carboplatin/etoposide as second-line chemotherapy has no significant survival impact, and it did not improve response rates.