Vinorelbine and Ifosfamide as Third-line Treatment for Refractory Small Cell Lung Cancer

• the disease control rate [ Time Frame: up to 9 weeks ] [ Designated as safety issue: No ]
  The disease control rate includes the rate of progression disease,partial remission and stable disease.
  
  

• progression free survival [ Time Frame: up to 52 weeks (about one year) ] [ Designated as safety issue: No ]
  From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 52 weeks.
  
  
• Overall survival [ Time Frame: Up to 100 weeks ] [ Designated as safety issue: No ]
  From date of randomization until the date of death from any cause, assessed up to 100 weeks.
  
  
• the score of functional assessment of cancer treatment-lung (FACT-L) [ Time Frame: up to 52 weeks ] [ Designated as safety issue: No ]
  FACT-L ia assessed at different time points. (Date of randomization, 1 weeks after chemotherapy, every cycle of chemotherapy, every month after chemotherapy,up to 52 weeks)
  
  
• Number of participants with adverse events [ Time Frame: Up to six months ] [ Designated as safety issue: Yes ]
  The adverse events are assessed by National Cancer Institute-Common Toxicity Criteria (Version 3.0)(NCI-CTC).
  
  

Small cell lung cancer (SCLC) is a highly aggressive disease characterized by its rapid doubling time, high growth fraction, early development of disseminated disease, and dramatic response to first-line chemotherapy and radiation. Small cell lung cancer accounts for approximately 20%-25% lung cancer patients. SCLC patients are categorized as limited disease, defined as disease that is confined to the ipsilateral hemithorax that can be encompassed within a tolerable radiation port, or extensive disease (ED), defined as the presence of overt metastatic disease determined by imaging or physical examination. Two third of patients are diagnosed with ED at presentation. Despite the development of novel cytotoxic drugs, the therapeutic approach to SCLC has been stagnant for more than twenty years. Standard treatment for ED-SCLC remains EP or CE, a regimen that yield a median survival of approximately 9 months and a 5-year survival of less than 1%.

Most patients are destined to relapse, and the prognosis for this group of patients who relapse is poor. Patients who relapse < 3 months after first-line therapy are commonly called refractory, and patients who relapse 3 months after therapy are labeled as sensitive. In a randomized multicenter study, von Pawel et al compared cyclophosphamide, adriamycin, and vincristine (CAV) with topotecan as a single agent in patients who had relapse at least 60 days (2 months) after initial therapy. The response rates were 24.3% in patients treated with topotecan and 18.3% in patients treated with CAV (P=0.285). Median times to progression were 13.3 weeks for the topotecan arm and 12.3 weeks for the CAV arm. Median survival times were 25 weeks for topotecan and 24.7 weeks for CAV. The proportion of patients with symptom improvement was greater in the topotecan arm than in the CAV arm. The authors concluded that topotecan was at least as effective as CAV in the treatment of patients with recurrent SCLC. So in some guidelines for SCLC, topotecan is recommended as the standard second-line treatment in patients who relapse less than 3 months. As for patients who relapse more than six months after the end of initial treatment, EP or CE regimen is recommended to be used again.