Topotecan in small cell lung cancer

Lung cancer continues to be the leading cause of cancer-related death in both men and women. According to the American Cancer Society, 160,400 people are predicted to die from this disease in 1997. Approximately 20% to 25% of lung cancer cases are classified as small cell lung cancer (SCLC). Although initial response rates to chemotherapy and radiation therapy are high among SCLC patients, nearly all these patients will eventually relapse and require additional treatment. The search for better treatments in relapsed SCLC is thus a high priority. In particular, it is hoped that the availability of new non-cross-resistant chemotherapeutic agents such as topotecan (Hycamtin; SmithKline Beecham Pharmaceuticals, Philadelphia, PA), a topoisomerase I inhibitor, will expand the treatment options. Because results from preclinical studies and phase I trials suggested that topotecan has activity in SCLC, the efficacy of this agent is currently being assessed in phase II and III clinical trials. Results from these trials, summarized here, suggest that topotecan may be a valuable alternative in the treatment of SCLC.