SCLC Studies Flashcards
Which paraneoplastic syndromes are a/w SCLC?
SCLc
- SIADH
- Cerebellar ataxia
- Lambert-Eaton syndrome
How is RT sequenced w/ CHT for SCLC?
- Early RT leads to improved survival
– Early starts w/ cycle 1 or 2 of CHT (~30 days). - Pts with massive lymphadenopathy that would require large radiation fields may benefit from receiving 1-2 cycles of induction chemotherapy for cytoreduction with the goal of starting thoracic radiation with cycles 2 or 3.
What was the pt population, randomization, and results of the CREST trial (Slotman et al., 2015)?
- Pt: ES-SCLC who had a response to chemotherapy
– Only underwent CNS imaging if they had sx - Randomization:
- CHT + PCI
- CHT + 30 Gy consolidative RT + PCI
- Results: 1 vs. 2
– Primary EP: 1-yr OS: 33% vs. 28%, NS
– Secondary analysis: 2-yr OS: 13% vs. 3%, SS
– 6-mo PFS: 24% vs. 7%, SS
– Intrathoracic progression alone: 19.8% vs. 46.0%, SS
– Side effects were statistically equivalent between the arms. Specifically, grade ≥3 esophageal toxicity was minimal (1.6% vs. 0%).
Conclusion: Patients w/ ES-SCLC who respond to CHT and receive PCI benefit from 30 Gy consolidative RT with an improvement in 2-year overall survival.
Memory Hook: CREST → Extensive STage
What were the findings of the Dutch randomized trial of PCI ± hippocampus avoidance for SCLC?
- PCI ± hippocampus avoidance
– No difference in cognitive decline
– No difference in brain met incidence
What were the findings of the CONVERT randomized trial BID vs. QD RT for LS-SCLC?
- 45 BID vs. 66 QD
– Median OS: 30 mos vs. 25 mos (NS)
– 2-yr OS: 56% vs. 51% (NS)
– 5-yr OS: 34% vs. 31% (NS)
What were the findings of the PREMER randomized trial of PCI ± hippocampus avoidance for SCLC?
- Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC.
- No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.
What can be included in an LS field for SCLC?
- Contralateral mediastinum
- Ipsilateral SCV
Is contralateral hilar involvement ES- or LS- SCLC?
- ES
What were the findings of the Pignon MA of LS-SCLC tx w/ CHT ± RT?
5.4% 3-yr OS benefit w/ +RT:
What were the findings of the Turrisi trial INT0096 (NEJM, 1999), which randomly assigned LS-SCLC to 45 Gy BID vs. 45 Gy QD?
- 45 Gy BID vs. 45 GyQD
– Median survival: 23 vs 19 months, SS
– 5-yr OS: 26% vs .16%, SS
– Grade 3 esophagitis: 27% vs 11%, SS
What is the average rate of Gr 3 esophagitis for pts receiving RT for LS-SCLC?
~20%
What were the findings of the Phase II THORA trial (Gronberg, Lancet, 2021), which randomly assigned LS-SCLC to 45 Gy BID vs. 60 Gy QD w/ concurrent CHT?
- 60 Gy vs. 45 Gy
– 2-yr OS: 75% vs. 48%, SS (OR = 3.09)
– Similar PFS although there was a trend toward improvement in the high-dose arm
– Rates of grade 3-4 toxicities, including hematologic and esophagitis, were similar across arms.
What were the findings and criticisms of EORTC 08993 (Slotman et al. NEJM 2007) randomized patients w/ ES-SCLC w/ any disease response after CHT 4-6 cycles to PCI or no further therapy?
- No PCI vs. PCI
– 1-yr incidence of brain metastases: 40.4% to 14.6%, SS
– 1-yr OS 27.1% vs. 13.3%, SS
– 1-yr extracranial progression: 88.8% vs. 92.8%, NS - Criticisms:
– Lack of pre-randomization brain imaging as patients were only required to undergo imaging for symptoms.
– It is possible that a proportion of patients had occult intracranial metastatic disease at the time of randomization which may have contributed to the OS beneft
What were the findings of the Takahashi phase III trial (Lancet Oncol 2017) for pts ES-SCLC and any response to chemotherapy to PCI (25 Gy in 10 fx) vs. observation?
- PCI vs. no PCI
– Median OS: 11.6 mos vs. 13.7 mos (NS)
– 1-yr OS: 48% vs. 54% (NS)
– Brain metastases incidence: 48% vs. 69% (NS) - As compared to Slotman, 2007:
– Required brain imaging prior to randomization - CHT and RT were more standardized
