A randomized trial to compare intravenous and oral etoposide in combination with cisplatin for the treatment of small cell lung cancer

In a randomized multi‐center study, 83 patients with small cell lung cancer were randomly assigned to treatment with cisplatin 100 mg/m² intravenously (IV) day 1 and etoposide 120 mg/m² IV days 1, 2, and 3 or cisplatin 100 mg/m² IV day 1 and etoposide 120 mg/m² IV day 1 and 240 mg/m² orally days 2 and 3. Both regimens were repeated every 4 weeks. Prior to randomization, patients were stratified by extent of disease, performance status, and gender. A total of 41 patients were randomly assigned to the parenteral treatment only regimen, and 42 patients received cisplatin and IV/oral etoposide therapy. Both treatment arms were comparable regarding patient characteristics. Limited disease (LD) patients constituted 52% and 49% of the patient population for the oral and IV etoposide regimens, respectively. The overall complete response (CR) and partial response (PR) rate was 50% (95% confidence interval [CI] 35% to 65%) for the oral etoposide regimen and 59% (95% CI 44% to 74%) for the IV etoposide regimen (P = 0.438). For both regimens, 55% of the LD patients achieved either CR or PR. Time to progression and survival were comparable for both treatment arms. Hematologic toxicity was comparable in both treatment arms, with 80% of patients experiencing grade 3 or 4 neutropenia or thrombocytopenia. Moderate to severe anemia and weight loss were more predominant with the IV than with the oral regimen.