Piotr Wysocki, Professor of Medicine and Head of the Department of Oncology at Jagiellonian University Hospital, shared on LinkedIn:

“Spiegel DR et al. published results of a phase III RESILIENT trial comparing two second-line treatments in patients with small-cell lung cancer (SCLC). The study enrolled 461 patients randomly assigned (1:1) to intravenous liposomal irinotecan d1 q2w or intravenous topotecan d1-5 q3w.
After a median follow-up of 18.4 months:

• The median OS was 7.9 months v 8.3 months for liposomal irinotecan and topotecan, respectively (HR=1.11; 95%CI 0.90 to 1.37)
• The median PFS was 4.0 months v. 3.3 months for liposomal irinotecan and topotecan, respectively (HR=0.96; 95%CI 0.77 to 1.20).
• ORR was 44.1% and 21.6% for liposomal irinotecan and topotecan, respectively.

Topotecan-based treatment was associated with a higher rate of G3-4 adverse events (83.4%) compared to liposomal irinotecan (42.0%)

The RESILIENT study demonstrates that liposomal irinotecan in advanced SCLC patients does not improve outcomes compared to topotecan despite a higher rate of objective responses and lower toxicity.

This study assumes that topotecan, along with other older agents (irinotecan, docetaxel, paclitaxel), remains the wise treatment choice and that novel, expensive irinotecan formulation does not make a difference.

In my clinical practice, in patients with relatively slowly progressing SCLC, especially if asymptomatic, without imminent risk of visceral crisis, I prefer using metronomic chemotherapy based on a combination of topotecan (1 mg/d p.o.) + cyclophosphamide (50 mg/d).

In other patients (more symptomatic, rapidly progressing, excessive visceral disease), my choices are based on intravenous regimens proposed by the NCCN guidelines.”

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Source: Piotr Wysocki/LinkedIn