FOLFIRI in advanced platinum-resistant/refractory small-cell lung cancer: a retrospective study

Abstract

Background

Small-cell lung cancer (SCLC) accounts for approximately 15% of lung cancer and is associated with poor prognosis. In platinum-refractory or -resistant SCLC patients, few treatment options are available. Topotecan is one of the standards of care for these patients, however, due to its high toxicity, several different approaches are employed. FOLFIRI (folinate, 5-fluorouracil and irinotecan) is a chemotherapy regimen used in digestive neuroendocrine carcinoma, which shares pathological similarities with SCLC. In this retrospective study, we evaluated the efficacy and safety of FOLFIRI in patients with platinum-resistant/refractory SCLC.

Methods

Medical records from all consecutive SCLC patients treated with FOLFIRI in a French University Hospital from 2013 to 2021 were analyzed retrospectively. The primary endpoint was the objective response rate according to RECIST v1.1 or EORTC criteria (ORR); secondary endpoints included duration of response, disease control rate, progression-free survival (PFS), overall survival (OS) and safety profile.

Results

Thirty-four patients with metastatic platinum-resistant (n = 14) or -refractory (n = 20) SCLC were included. Twenty-eight were evaluable for response, with a partial response observed in 5 patients for an overall ORR in the evaluable population of 17.9% (5/28) and 14.7% (5/34) in the overall population. The disease control rate was 50% (14/28) in the evaluable population. The median PFS and OS were 2.8 months (95%CI, 2.0–5.2 months) and 5.3 months (95%CI, 3.5–8.9 months), respectively. All patients were included in the safety analysis. Grade 3 or 4 adverse events occurred in 13 (38.2%) patients. The most common grade 3 or 4 adverse events were asthenia, neutropenia, thrombopenia and diarrhea. There was no adverse event leading to discontinuation or death.

Conclusion

FOLFIRI showed some activity for platinum-resistant/refractory SCLC in terms of overall response and had an acceptable safety profile. However, caution is needed in interpreting this result. FOLFIRI could represent a potential new treatment for platinum-resistant/refractory SCLC patients. Further prospective studies are needed to assess the benefits of this chemotherapy regimen.

HIGHLIGHTS

• FOLFIRI showed some activity for platinum-resistant/refractory SCLC in terms of overall response.

• FOLFIRI was well-tolerated in platinum resistant/refractory SLCL patients.

• FOLFIRI could represent a potential new treatment for SCLC, prospective studies are needed.

Keywords:

• Small-cell lung cancer
• 5-Fluorouracil
• Irinotecan
• FOLFIRI
• Retrospective study

Ethics statement

All living patients received written information and provided their oral consent for data collection. Patients’ clinical charts were retrospectively collected from electronic files using a de-identified form. This study was approved by the Inserm Ethics Evaluation Committee (CEEI) on December 6th 2022: 22-973.

Author contributions

Roussel-Simonin Cyril: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Visualization; Writing original draft; Writing review & editing.

Gougis Paul and Lassoued Donia: Formal analysis; Data curation; Methodology; Visualization; Writing review & editing.

Vozy Aurore, Veyri Marianne, Morardet Laetitia, Wassermann Johanna, Foka Tichoue Hervé, Jaffrelot Loïc, Hassani Lamia, Perrier Alexandre, Bergeret Sebastien, Taillade Laurent, Spano Jean-Philippe: Resources; Writing review & editing.

Campedel Luca: Conceptualization; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Writing review & editing.

Abbar Baptiste: Conceptualization; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Writing review & editing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, [BA], upon reasonable request.

Additional information

Funding

PG has received consultant fees from BMS, and grant funds from Sanofi. DL has received consultant or advisory role fees or meeting invitations from Pfizer, Sanofi, AstraZeneca, Amgen and Sanofi. AV has received travel reimbursement from Amgen and Merck. MV has received honoraria from Gilead. JW has received consultant or advisory role fees or meeting invitations from Pfizer, Eisai, GSK, Bayer and Amgen. LJ has received consultant or advisory role fees from Bayer. JPS has received consultant or advisory role fees or meeting invitations from Roche, MSD, Biogaran, AstraZeneca, Leopharma, Mylan, Pfizer, BMS, Novartis, PFO, Myriads, Gilead and Lilly. LC serves as a consultant/receives honorarium/travel reimbursements from Pfizer, BMS, MSD, Bayer, Janssen and Ipsen. BA has received consultant or advisory role fees or meeting invitations from Novartis, Astellas, Sanofi, AstraZeneca, Janssen, MSD, Pfizer, IPSEN Pharma, Takeda.