Progression of central nervous system (CNS) metastases from small cell lung cancer (SCLC) after radiation therapy is associated with a poor prognosis.
Case reports
We present two cases of patients with progressive CNS metastases from SCLC treated with oral temozolomide and etoposide. Sustained clinical responses and radiographic stability were demonstrated. The palliative chemotherapy regimen was well tolerated.
Discussion
A regimen of oral temozolomide and etoposide for progressive CNS metastases from SCLC is well tolerated and may be associated with sustained stability of disease.
SimonG.R., TurrisiA., American College of Chest Physicians: Management of small cell lung cancer: ACCP evidence-based clinical practice guidelines (2nd ed).Chest, 132(3 Suppl): 324S–339S, 2007.
2.
GrossiF., ScolaroT., TixiL., LopreviteM., ArdizzoniA.: The role of systemic chemotherapy in the treatment of brain metastases from small-call lung cancer.Crit Rev Oncol Hematol, 37: 61–67, 2001.
3.
SperdutoP.W., KasedN., RobergeD., XuZ., ShanleyR., LuoX., SneedP.K., ChaoS.T., WeilR.J., SuhJ., BhattA., JensenA.W., BrownP.D., ShihH.A., KirkpatrickJ., GasparL.E., FiveashJ.B., ChiangV., KniselyJ.P., SperdutoC.M., LinN., MehtaM.: Summary report on the Graded Prognostic Assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases.J Clin Oncol, 30: 419–425, 2012.
4.
SeuteT., LeffersP., ten VeldeG.P., TwijnstraA.: Leptomeningeal metastases from small cell lung carcinoma: frequencies and survival.Cancer, 104: 1700–1705, 2005.
5.
MehtaM.P., PaleologosN.A., MikkelsenT., RobinsonP.D., AmmiratiM., AndrewsD.W., AsherA.L., BurriS.H., CobbsC.S., GasparL.E., KondziolkaD., LinskeyM.E., LoefflerJ.S., McDermottM., OlsonJ.J., PatchellR.A., RykenT.C., KalkanisS.N.: The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline.J Neurooncol, 96: 71–83, 2010.
6.
BahlA., KumarM., SharmaD.N., Jothy BasuK.S., JauraM.S., RathG.K., JulkaP.K.: Reirradiation for progressive brain metastases.J Cancer Res Ther, 5: 161–164, 2009.
7.
AmmiratiM., CobbsC.S., LinskeyM.E., PaleologosN.A., RykenT.C., BurriS.H., AsherA.L., LoefflerJ.S., RobinsonP.D., AndrewsD.W., GasparL.E., KondziolkaD., McDermottM., MehtaM.P., MikkelsenT., OlsonJ.J., PatchellR.A., KalkanisS.N.: The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline.J Neurooncol, 96: 85–96, 2010.
8.
StuppR., MasonW.P., van den BentM.J., WellerM., FisherB., TaphoornM.J., BelangerK., BrandesA.A., MarosiC., BogdahnU., CurschmannJ., JanzerR.C., LudwinS.K., GorliaT., AllgeierA., LacombeD., CairncrossJ.G., EisenhauerE., MirimanoffR.O., European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.New Engl J Med, 352: 987–996, 2005.
9.
AddeoR., De RosaC., FaiolaV., LeoL., CennamoG., MontellaL., GuarrasiR., VincenziB., CaragliaM., Del PreteS.: Phase 2 trial of temozolomide using protracted low-dose and whole-brain radiotherapy for nonsmall cell lung cancer and breast cancer patients with brain metastases.Cancer, 113: 2524–2531, 2008.
10.
GiorgioC.G., GiuffridaD., PappalardoA., RussoA., SantiniD., SaliceP., BlancoG., CastorinaS., FaillaG., BordonaroR.: Oral temozolomide in heavily pre-treated brain metastases from non-small cell lung cancer: phase II study.Lung Cancer, 50: 247–254, 2005.
11.
PietanzaM.C., KadotaK., HubermanK., SimaC.S., FioreJ.J., SumnerD.K., TravisW.D., HeguyA., GinsbergM.S., HolodnyA.I., ChanT.A., RizviN.A., AzzoliC.G., RielyG.J., KrisM.G., KrugL.M.: Phase II trial of temozolomide in patients with relapsed sensitive or refractory small cell lung cancer, with assessment of methylguanine-DNA methyltransferase as a potential biomarker.Clin Cancer Res, 18: 1138–1145, 2012.
12.
ManapovF.: Central nervous system relapse continues to be a therapeutic challenge in extensive disease small-cell lung cancer patients with initial symptomatic brain metastases and good response to chemoradiotherapy.J Neurooncol, 98: 349–355, 2010.
13.
MalacarneP., SantiniA., MaestriA.: Response of brain metastases from lung cancer to systemic chemotherapy with carboplatin and etoposide.Oncology, 53: 210–213, 1996.
14.
EbertB.L., NiemierkoE., ShafferK., SalgiaR.: Use of temozolomide with other cytotoxic chemotherapy in the treatment of patients with recurrent brain metastases from lung cancer.Oncologist, 8: 69–75, 2003.
