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S-1 and irinotecan for non-small cell lung cancer
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As a gastrointestinal oncologist, I use irinotecan and 5-FU a lot. We also have in trial at my institution S-1, an oral compound which is a 5-FU prodrug, used primarily in Asia. A lot of the abstracts at ASCO GI every year revolve around S-1. I was somewhat surprised however when I came across a Japanese article about efficacy with S-1 and irinotecan in non–small cell lung cancer from Clinical Cancer Research. This article, by Okamoto, was published today.
This phase-2 study reported that amongst 56 chemotherapy-naïve patients, they found a response rate of 29% and an additional 43% with stable disease, and a median progression free survival of 4.9 months. The side effects were to be expected, with neutropenia, anorexia and leucopenia topping the grade-3 and 4 list. Surprisingly, only 8.9% experienced diarrhea of any grade, but I suspect that is because irinotecan (CPT-11) was only given at 150 mg/m2 every three weeks. The S-1 dose was 80 mg/m2 days 1-14.
I had seen prior data with cisplatin and irinotecan in small cell lung cancer, but at least at my institution, I don't think that regimen has clearly trumped standard cisplatin and etoposide. But this trial looks more compelling. I wonder if it will make its way into a head-to-head comparison with a platinum doublet in front-line treatment? I'm recalling also that first bevacizumab moved into lung cancer from its previous stronghold only in GI cancers, then cetuximab made the same move, and now this. I'm beginning to feel like a lung cancer doctor!