These findings have direct consequences for the pathogenesis and classification of lung cancer. First, SCLC should be differentiated into primary and secondary carcinomas. Second, neuroendocrine differentiation in lung carcinomas should be used as a marker for dedifferentiation, worse prognosis and rapid tumor progression rather than an indicator of a putative tumor stem cell. This regimen could not be intensified with carboplatin because of synergistic granulocytopenia. Pharmacodynamic modelling revealed that the granulocyte nadir could be predicted from a single plasma etoposide level drawn on the second day of therapy, potentially allowing dose adjustment during the treatment cycle.
Oral chemotherapy remains a promising route for the treatment of lung cancer.
PI TI - Current role of oral etoposide in the management of small cell lung cancer. Current evidence suggests that, in SCLC, the optimal schedule of administration is over 3 to 5 days. Its use as a single agent for palliation cannot be supported, but it has a continued use within combination chemotherapy for most patients. In addition, it is likely to be incorporated into regimens with new agents that may offer significant advantages over current combinations. Sixty-five chest helical CT studies were reviewed.