Cancer Treatment Today » Small Cell Lung Cancer

Irinotecan for brain metastases of lung and breast cancer

M Levin, MD — Fri, 09 Nov 2012 15:38:40 +0000

Because irinotecan penetrates the brain-blood barrier and has an effect in primary brain cancer, there is some interest in using it for brain metastasis, especially for lung cancer and breast cancer. Most studies of irinotecan had been for brain mets of small(SCLC) and non-small cell lung cancer(NSMCLC) and not breast cancer and have had mixed results. One study enrolled several different cancer types and reported complete responses with irinotecan-based chemotherapy for brain metastases in three patients with SCLC, parotid cancer, and esophageal adenocarcinoma. The combination of cisplatin, ifosfamide and irinotecan in treatment-naive patients with NSCLC led to a response rate in the brain of 50%. A study of temozolomide (200 mg/m²) on days 1 to 5 and irinotecan (200 mg/m²) on days 1 to 5 every 4 weeks in previously untreated patients with NSCLC brain metastases reported no responses.

There are several ongoing studies for lung cancer. For breast cancer, there is also a study: Irinotecan and Temozolomide in Treating Patients With Breast Cancer Who Have Received Previous Treatment for Brain Metastases, NCT00617539.

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Temodar for small cell lung cancer

M Levin, MD — Fri, 24 Aug 2012 17:39:22 +0000

Among solid tumors, small cell lung cancer(SCLC) is unusual in that it has the highest incidence of brain metastases. Several phase II trials have been reported using Temodar(TEM) for patients with brain metastases from solid tumors, including SCLC. In one study, two out of five patients with SCLC pretreated with whole brain radiation therapy showed disease stabilization with TEM. A second study explored the use of whole-brain radiation therapy with concurrent and adjuvant TEM in patients with metastatic cancer and three patients with SCLC were included in this study, two of whom demonstrated a complete response in the brain. Anecdotally, single-agent TEM has been used in patients with SCLC with response. Memorial Sloan-Kettering Cancer Center has an ongoing phase II study using TEM in second- or third-line treatment of SCLC: Temozolomide for Relapsed Sensitive or Refractory Small Cell Lung Cancer, NCT00740636. Most of this work appears to have been done by one investigator in a single institution, Dr. Pietanza in Memorial, who is also the author on the two reported phase II trials, which seem based on the same body of experience.

In first line, small cell lung cancer patients usually get radiation. For second line chemotherapy, NCCN recommends many single agents on SCL-B,1, including paclitaxel, etoposide, irinotecan, topotecan, ifosfamide and others but not Temodar at this time.

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SAMSA – A New Drug for Low Sodium

M Levin, MD — Fri, 10 Aug 2012 00:33:57 +0000

SAMSCA(tolvaptan) is indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia (low blood serum sodium <125 mEq/L or less marked hyponatremia that is symptomatic and has resisted correction with fluid restriction), including patients with heart failure, cirrhosis, and Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The latter condition occurs with lung cancer, especially small lung cancer, and less commonly other cancer or in associations with certain chemotherapy drugs that are used to treat cancer, such as cisplatin.

SAMSCA should be initiated and re-initiated in patients only in a hospital where serum sodium can be monitored closely. This allows observing for side effects and to titrate to an appropriate dose. The FDA aproved Prescribing information says: “The usual starting dose for SAMSCA is 15 mg administered once daily without regard to meals. Increase the dose to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as needed to achieve the desired level of serum sodium. ”

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