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According to results recently presented at the 2005 annual meeting of the American Society of Clinical Oncology, the chemotherapy agent Hycamtin (topotecan) taken orally in the form of a pill plus the chemotherapy agent cisplatin (Platinol®) produce nearly equivalent outcomes with increased convenience compared to the intravenous form of etoposide (VePesid®) plus cisplatin in extensive small cell lung cancer.

Lung cancer is the leading cause of cancer-related deaths in the United States and Europe. There are two main types of lung cancer, small cell lung cancer and non-small cell lung cancer. The distinction in lung cancer types often determines the treatment options since each type responds differently to treatment.

Current treatment options for SCLC include surgery, chemotherapy and radiation. The chemotherapy regimen considered the standard of care for the treatment of extensive stage SCLC is the combination of the drugs etoposide and cisplatin. However, this combination has the immediate drawback of being administered intravenously (into a vein). Intravenous administration of drugs means that patients must make extended office visits-particularly inconvenient if a patient lives far from a medical facility that administers chemotherapy agents. Other complications include increased risk of pain, infection and greater medical costs than drugs given orally.

Researchers recently conducted a clinical trial to compare the effectiveness of the oral administration of Hycamtin in addition to cisplatin to the standard intravenous administration of etoposide/cisplastin as initial treatment for extensive-stage SCLC. Of the 784 patients participating, overall anti-cancer responses were achieved in 63 percent of patients treated with oral Hycamtin/cisplatin and in 69 percent of patients treated with etoposide/cisplatin. The average overall survival was almost the same in both groups (39 weeks for oral Hycamtin and 40 weeks for etoposide). Survival at one year was 31.4 percent for both groups as well. Severe side effects included vomiting and low levels of immune cells for the group treated with etoposide. Those treated with oral Hycamtin experienced low levels of platelets and red blood cells as well as diarrhea.

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The researchers concluded that the oral form of Hycamtin produces nearly equivalent outcomes to that of the standard intravenous administration of etoposide in combination with cisplatin as initial therapy for extensive-stage SCLC. Oral administration provides considerably more convenience for patients compared to intravenous administration. Patients diagnosed with extensive-stage SCLC may wish to speak with their physician about their individual risks and benefits of participating in a clinical trial further evaluating the oral form of Hycamtin.

Reference: Eckardt J, von Pawel J, Manikhas G et al. Comparable activity with oral topotecan/cisplatin (TC) and IV etoposide/cisplatin (PE) as treatment for chemotherapy-naïve patients (pts) with extensive disease small cell lung cancer (ED-SCLC): Final results of a randomized phase III trial (389). Proceedings of the 2005 meeting of the American Society of Clinical Oncology:abstract 7003.

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