Carboplatin plus etoposide versus topotecan as second-line treatment for patients with sensitive relapsed small-cell lung cancer: an open-label, multicentre, randomised, phase 3 trial

French RCT (n=164) found that, after median follow-up of 22.7 months, progression-free survival was longer in the combination chemotherapy group than in the topotecan group (4.7 vs 2.7 months, HR for progression or death 0.57, 95% CI 0.41-0.73).

SPS commentary:

A related commentary highlights that the study took considerable time to enrol sufficient numbers of patients and during this period, immunotherapy and chemotherapy combinations became the standard of care. Thus, reasonable doubts emerge regarding the application of this strategy in patients receiving immunotherapy. The benefit of a rechallenge strategy after immunotherapy use remains unknown and should be defined by future studies. The usefulness of immunotherapy combined with a retreatment strategy after progression also poses an exciting avenue for future studies. 

The commentary concludes that there is an urgent need to develop new strategies and biomarkers to overcome the current poor prognosis for patients with small-cell lung cancer. Exploratory approaches with combination therapies offer hope for this fatal disease. Until then, this study positions an out-of-date strategy as an attractive and feasible approach in the modern oncology era, by showing that retreatment with carboplatin plus etoposide is a viable, accessible, and perhaps less costly option in patients with sensitive relapse or progression after an initial response with a platinum based regimen.


The Lancet Oncology

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