Temodar for small cell lung cancer
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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