Küçük hücreli akciğer kanseri tedavisinde ikinci hat irinotekan kemoterapisinin etkinliği

Amaç: Küçük hücreli akciğer kanseri (KHAK), genellikle ileri evrede saptanan ve progresif seyreden bir hastalıktır. Çalışmamızın amacı ikinci hat olarak irinotekan kemoterapisi alan KHAK tanılı hastaların kemoterapi yanıtlarının ve hematolojik yan etkilerinin retrospektif olarak değerlendirilmesidir. Gereç ve Yöntem: Çalışmaya, kliniğimizde küçük hücreli akciğer kanseri tanısıyla birinci hat kemoterapiyi tamamlamış ve ardından 01.01.2009-01.01.2011 tarihleri arasında ikinci hat olarak irinotekan kemoterapisi almış, arşiv materyalinde hastalar ve tedavileri hakkında yeterli bilgi bulunan, 30-80 yaş arasında 18 hasta dahil edilmiştir. Tüm hastalar ikinci hat tedavide en azından bir kür irinotekan kemoterapisi almıştır. Veri analizi de SPSS programı kullanılarak yapılmıştır. Bulgular: 18 hasta değerlendirmeye alınmıştır. Hastaların yaş ortalaması 58.9±7.6 ve %89unu erkek hastalar oluşturmaktadır. Birinci hat kemoterapi sonrası hastaların %78inde yanıt sağlandığı, %6sında ise progresyon olduğu gözlenmiştir. İrinotekan ile yapılan ikinci hat kemoterapi sonrası radyolojik değerlendirme yapıldığında hastaların sadece %17sinde kısmi yanıt gözlendiği, %61inde progresyon, %22sinde stabil yanıt olduğu saptanmıştır. İrinotekan kemoterapisi ile hastaların %28inde semptomlarda düzelme sağlanmıştır. Ortalama sağkalım tanıdan itibaren 91.2±40.2 hafta, irinotekan sonrası sağkalım 31.2±17.2 hafta ve progresyona kadar geçen süre 15.5±12.0 hafta olarak hesaplanmıştır. Hastaların %6sına kan transfüzyonu yapılmış, %22sinde ise en az bir kez nötropeni gözlenmiştir. Sonuç: KHAKnin ikinci hat kemoterapisinde irinotekan verilen hastalarda kemoterapi yanıt oranları düşük olmasına karşın irinotekan kemoterapisinin kısmen tolere edilebilir olduğu gösterilmiştir.

Effectiveness of irinotecan as second-line chemotherapy in small cell lung cancer

Aim: Small cell lung cancer (SCLC) is a progressive and advanced disease. The purpose of this study is to evaluate the response and the hematological side effects of irinotecan chemotherapy in patients with SCLC retrospectively. Materials and Methods: Eighteen patients were included in our study who were between the ages of 30-80 years, had a diagnosis for SCLC, had completed first-line chemotherapy and had taken second-line irinotecan chemotherapy between 01.01.2009 and 01.01.2011. The patients also had archival material which included sufficient information about them and their treatments. All patients had taken at least one course of irinotecan chemotherapy. Data analysis was performed using the SPSS program. Results: Eighteen patients were evaluated. The mean age of the patients was 58.9±7.6 and 89% of the patients were male. After the first-line chemotherapy, treatment response was seen in 78% of the patients and progression was observed in 6% of them. When a radiological evaluation was made after the second-line chemotherapy with irinotecan, a partial response was observed in only 17% of patients, with progression was observed in 61% and stable response was found in 22% of patients. With irinotecan chemotherapy in 28% of patients got improvement of symptoms. The median survival from diagnosis was calculated 91.2±40.2 weeks, the median survival after irinotecan chemotherapy was 31.2±17.2 weeks and time to progression was 15.5±12.0 weeks. Blood transfusion was applicated in 6% of patients and the neutropenia have been observed at least one times in 22% of the patients. Conclusion: It is showed that the second-line irinotecan chemotherapy is partially tolerable although the chemotherapy response rates are low.

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1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74-108.
2. Jemal A, Murray T,Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55(1):10-30.
3. Kathryn Chrystal, Kerry Cheong and Peter Harper. Chemotherapy of small cell lung cancer: state of the art. Curr Opin Oncol 2004;16(2):136-40.
4. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 2000;92(3):205-16.
5. Ebi N, Kubota K, Nishiwaki Y, et al. Second-line chemotherapy for relapsed small cell lung cancer. Jpn J Clin Oncol 1997;27(3):166-9.
6. Giaccone G, Ferrati P, Donadio M, Testore F, Calciati A. Reinduction chemotherapy in small cell lung cancer. Eur J Cancer 1987;23(11):1697-9.
7. Vincent M, Evans B, Smith I. First-line chemotherapy rechallenge after relapse in small cell lung cancer. Cancer Chemother Pharmacol 1988;21(1):45-8.
8. DeVore RF, Blanke CD, Denham CA, et al. Phase II study of irinotecan (CPT-11) in patients with previously treated small-cell lung cancer (SCLC). Proc Am Soc Clin Oncol 1998(1);1736.
9. Sevinc A, Kalender ME, Altinbas M, Ozkan M, Dikilitas M, Camci C. Irinotecan as a second-line monotherapy for small cell lung cancer. Asian Pac J Cancer Prev 2011;12(4):1055-9.
10. Schuette W. Chemotherapy as treatment of primary and recurrent small cell lung cancer. Lung Cancer 2001;33(1):99-107.
11. Schmittel A. Second-line therapy for small-cell lung cancer. Expert Rev Anticancer Ther 2011;11(4):631-7.
12. Shiozawa T, Tadokoro J, Fujiki T, et al. Risk factors for severe adverse effects and treatment-related deaths in Japanese patients treated with Irinotecan-based chemotherapy: A postmarketing survey. Jpn J Clin Oncol 2013;43(5):483-91.
13. Cha P, Mushiroda T, Zembutsu H, et al. Single nucleotide polymorphism in ABCG2 is associated with irinotecan-induced severe