A Retrospective Analysis of Topotecan Treatment in Small Cell Lung Cancer

Öz

Small cell lung cancer (SCLC) is a subtype of lung cancer known to be associated with smoking and characterized by poor prognosis. Topotecan, a topoisomerase-1 inhibitor, is an important treatment options used in second-line and later settings for SCLC. This study aimed to present our clinical experience with topotecan in the treatment of SCLC patients. We retrospectively reviewed the medical records of 27 patients diagnosed with SCLC who received topotecan treatment between 1 January 2017 and 20 April 2022. The median age was 62 years (range, 37-75). In terms of best treatment response, one patient achieved a partial response, four had stable disease, while disease progression was observed in 22 patients. Kaplan-Meier survival analysis showed a median progression-free survival (PFS) of 2.4 months (95% confidence interval [CI], 1.33-3.47) and a median overall survival (OS) of 3.73 months (95% CI, 1.41-6.05). Patients with liver metastases before topotecan treatment had significantly worse survival outcomes (PFS, Log Rank p=0.009; OS, Log Rank p=0.031). In multivariate Cox regression analysis, liver metastasis prior to treatment was identified as an independent risk factor for both PFS and OS. Treatment-related adverse events of any grade occurred in all patients. Although the results of our study should be interpreted with caution due to its single-center design and limited number of patients, this may be attributed to the use of a weekly topotecan regimen in the majority of patients (85.2%). Larger, multicenter studies are needed to improve survival outcomes and optimize treatment strategies in SCLC.

Anahtar Kelimeler

• cancer
• chemotherapy
• lung
• small cell lung cancer
• topotecan

Küçük Hücreli Akciğer Kanserinde Topotekan Tedavisinin Retrospektif Analizi

Öz

Küçük hücreli akciğer kanseri (KHAK), sigara ile ilişkili olduğu bilinen, kötü prognozlu bir akciğer kanseri alt tipidir. Topoizomeraz-1 inhibitörü olan topotekan, KHAK tedavisinde ikinci seçim ve sonrasında kullanılan önemli tedavi seçeneklerinden biridir. Çalışmamızda kliniğimizde takip, tedavi edilen KHAK hastalarının tedavisinde topotekan deneyimimizin aktarılması amaçlanmıştır. Çalışmamızda 1 Ocak 2017 ve 20 Nisan 2022 tarihleri arasında topotekan tedavisi başlanan 27 KHAK tanılı hastanın dosyası retrospektif olarak değerlendirilmiştir. Hastaların medyan yaşı 62 (aralık, 37-75) olarak izlenmiştir. Topotekan tedavisi ile en iyi yanıt durumu değerlendirildiğinde bir hastada kısmi yanıt, dört hastada stabil hastalık izlenirken; 22 hastada progresyon geliştiği görülmüştür. Kaplan-Meier sağkalım analizinde, medyan progresyonsuz sağkalım (PFS) 2,4 ay (%95 güven aralığı [GA], 1,33-3,47), medyan genel sağkalım (OS) 3,73 ay (%95 GA, 1,41-6,05) olarak saptanmıştır. Topotekan tedavisi öncesi karaciğer metastazı olan hastalarda sağkalımların daha kötü olduğu izlenmiştir (PFS, Log Rank p=0,009; OS, Log Rank p=0,031). Çok değişkenli Cox regresyon analizinde, topotekan tedavisi öncesi karaciğer metastazı varlığının PFS ve OS’yi etkileyen bağımsız bir risk faktörü olduğu gösterilmiştir. Herhangi bir derecede tedavi ilişkili advers olay tüm hastalarda gelişmiştir. Çalışmamızda topotekan tedavisi ile literatüre göre medyan PFS ve OS’nin nümerik olarak daha düşük olduğu görülmüştür. Çalışmamızın tek merkez ve sınırlı hasta sayısı içermesi nedeniyle sonuçlarının dikkatle değerlendirilmesi gerektiği düşünülmekle birlikte, bu durumun bir nedeni olarak, çoğu hastada (%85,2) haftalık topotekan rejiminin kullanılması olabileceği düşünülmüştür. KHAK tedavisinde, tedavi seçeneklerinin ve takip stratejilerinin geliştirilerek sağkalımların arttırılması için geniş kapsamlı, çok merkezli çalışmalara ihtiyaç bulunmaktadır.

Anahtar Kelimeler

• akciğer
• kanser
• kemoterapi
• küçük hücreli akciğer kanseri
• topotekan

Kaynakça

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