Carfilzomib and irinotecan in relapsed small cell lung cancer

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Published: 6 Jun 2019
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Dr Susanne Arnold - UK Markey Cancer Center, Lexington, USA

Dr Susanne Arnold talks to ecancer at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting about a phase II study looking into carfilzomib and irinotecan in relapsed small cell lung cancer.

She explains that there were two cohorts: platinum sensitive cancers and platinum resistant cancers.

Dr Arnold reports that in both cohorts at 6 months the overall survival was 59% for the platinum sensitive cohort and 54% for the platinum resistant cohort.

ecancer's filming has been kindly supported by Amgen through the ecancer Global Foundation. ecancer is editorially independent and there is no influence over content.

Our study was a study of carfilzomib and irinotecan in relapsed small cell lung cancer. We had two cohorts, the first was platinum sensitive cancers and the second was platinum resistant cancers. In both cohorts we showed a six month overall survival that was 59% and 54% respectively in both cohorts. What was unusual about that is that in resistant cancers we don’t normally see a high response rate or a high overall survival and at six months more commonly 25-40% of patients are alive and in our study over 50% were alive. That gives us a little bit of hope about small cell lung cancer, especially resistant small cell lung cancer which is a very hard cancer to treat.

Our study was not for poor performance status patients. We saw a high rate of grade 3 and 4 toxicities, the most common were diarrhoea and neutropenia but also fatigue and thrombocytopenia were also seen. We had three treatment related deaths, one was a myocardial infarction, one was a neutropenic sepsis and one was a pulmonary infection. Those are common in small cell cancer but it was a higher rate than we wanted in this population. So we do not recommend this combination for people who do not have a performance status of ECOG 0 or 1. They need to have a good performance status to be able to tolerate this combination.

What about patients who can’t receive immunotherapy?

Immunotherapy is the leading cutting-edge technology that has shown advance in small cell lung cancer and it’s moving from the second line to the first line setting. So in patients that aren’t able to tolerate immunotherapy carfilzomib plus irinotecan offers another option of treatment for well and fit patients with small cell cancer in relapse.

I don’t think that this combination changes the paradigm in first or second line treatment of small cell cancer but what it does is offers us hypothesis generating ideas for the future in resistant cancers in the small cell lung cancer space. We hope to see this combination used in a trial comparing it to other new therapies in resistant small cell lung cancer.