Quality-of-life considerations in patients with advanced lung cancer

Effect of topotecan on symptom palliation and quality of life

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44 Citations (Scopus)

Abstract

Key goals in the treatment of lung cancer are to improve both survival and quality of life (QOL). While formal techniques are frequently used to evaluate survival and response, such rigor is used less often in assessing the impact of treatment on quality of life. Many patients with lung cancer are elderly and have complex medical histories and a myriad of comorbidities. In these patients, with limited survival expectations, symptom palliation, quality of life, and convenience of therapy are especially important end points. Indeed, clinical trials are now incorporating symptom scores and QOL outcomes in their designs (now combined as "patient reported outcomes" or PROs). Moreover, symptom palliation correlates well with QOL and survival duration, providing further rationale for therapy selection based on these parameters. The potential palliative and QOL benefits of chemotherapy have been investigated for several agents in lung cancer trials. Of these, topotecan (Hycamtin® GlaxoSmithKline; Philadelphia, PA) is the best characterized in relapsed small cell lung cancer (SCLC). In a phase in trial of topotecan versus cyclophosphamide, doxorubicin (Adriamycin®; Bedford Laboratories; Bedford, OH), and vincristine (Oncovin® Eli Lilly and Company; Indianapolis, IN) (CAV) in patients with recurrent SCLC, topotecan was associated with statistically significant (p<0.05) improvements in general symptoms (e.g., fatigue and interference with daily activity) and disease-specific symptoms (e.g., dyspnea and hoarseness). Moreover, the introduction of oral therapies, such as oral topotecan, may increase the convenience of therapy by reducing the time needed for therapy and the need for frequent venipuncture. This review summarizes the role of chemotherapy in symptom palliation, with an emphasis on the impact of topotecan therapy on symptom parameters in patients with relapsed SCLC and the emerging role of oral therapy in this setting.

Original languageEnglish (US)
Pages (from-to)14-24
Number of pages11
JournalOncologist
Volume9
Issue numberSUPPL. 6
StatePublished - 2004
Externally publishedYes

Fingerprint

Topotecan
Lung Neoplasms
Quality of Life
Small Cell Lung Carcinoma
Therapeutics
Survival
Vincristine
Doxorubicin
Drug Therapy
Hoarseness
Phlebotomy
Dyspnea
Cyclophosphamide
Fatigue
Comorbidity
Clinical Trials

Keywords

  • Non-small cell lung carcinoma
  • Oral administration
  • Palliative therapy
  • Quality of life
  • Small cell lung carcinoma
  • Topotecan

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Hematology

Cite this

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title = "Quality-of-life considerations in patients with advanced lung cancer: Effect of topotecan on symptom palliation and quality of life",
abstract = "Key goals in the treatment of lung cancer are to improve both survival and quality of life (QOL). While formal techniques are frequently used to evaluate survival and response, such rigor is used less often in assessing the impact of treatment on quality of life. Many patients with lung cancer are elderly and have complex medical histories and a myriad of comorbidities. In these patients, with limited survival expectations, symptom palliation, quality of life, and convenience of therapy are especially important end points. Indeed, clinical trials are now incorporating symptom scores and QOL outcomes in their designs (now combined as {"}patient reported outcomes{"} or PROs). Moreover, symptom palliation correlates well with QOL and survival duration, providing further rationale for therapy selection based on these parameters. The potential palliative and QOL benefits of chemotherapy have been investigated for several agents in lung cancer trials. Of these, topotecan (Hycamtin{\circledR} GlaxoSmithKline; Philadelphia, PA) is the best characterized in relapsed small cell lung cancer (SCLC). In a phase in trial of topotecan versus cyclophosphamide, doxorubicin (Adriamycin{\circledR}; Bedford Laboratories; Bedford, OH), and vincristine (Oncovin{\circledR} Eli Lilly and Company; Indianapolis, IN) (CAV) in patients with recurrent SCLC, topotecan was associated with statistically significant (p<0.05) improvements in general symptoms (e.g., fatigue and interference with daily activity) and disease-specific symptoms (e.g., dyspnea and hoarseness). Moreover, the introduction of oral therapies, such as oral topotecan, may increase the convenience of therapy by reducing the time needed for therapy and the need for frequent venipuncture. This review summarizes the role of chemotherapy in symptom palliation, with an emphasis on the impact of topotecan therapy on symptom parameters in patients with relapsed SCLC and the emerging role of oral therapy in this setting.",
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