Re-challenge chemo may up survival in relapsing non-small-cell lung cancer

NEW YORK (Reuters Health) - Re-challenge chemotherapy (RC) may improve survival in patients with relapsing non-small-cell lung cancer (NSCLC) who responded to a first-line regimen, researchers suggest in the January issue of Lung Cancer.

"NSCLC is much less chemo-sensitive than small-cell lung cancer, and effective salvage chemotherapy, except for standard docetaxel, has not been identified until recently," said coauthor Dr. Young Hak Kim in an email to Reuters Health.

In a recent review of data on their patients, however, Dr. Kim's group found that responses to re-challenge, and survival, "were superior to those of the docetaxel arm."

The data were from 28 NSCLC patients treated with RC and 38 treated with docetaxel at the National Cancer Center Hospital East in Chiba, Japan, between 1992 and 2003. Median patient age was 62 years (range, 42 to 76 years) in the RC group and 67 years (range, 47 to 77 years) in the docetaxel group.

All of the patients had responded to first-line chemotherapy and had a performance status of 1 at relapse. The median interval from the end of first-line chemotherapy to relapse was 5.0 months (range, 1.6-36.1 months). All patients received second-line chemotherapy upon disease progression.

According to the paper, the overall response rate was 29% in the RC group and 8% in the docetaxel group (p = 0.043). Median survival after starting second-line chemotherapy was 17.0 months (range, 0.4-43.0) in the RC group and 9.0 months (range, 1.3-31.4) in the docetaxel group. One-year survival rates were 60% and 29% for RC and docetaxel patients, respectively (p = 0.034).

The authors note, however, that the results should be interpreted with caution because there may be a potential imbalance of prognostic factors between the groups. Furthermore, the population was small and the data were old.

Nevertheless, "this study may suggest that RC has potential to become a treatment option for relapsed NSCLC patients if the previous chemotherapy had been effective and relapsed patients maintained good performance status," the investigators conclude.

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