Topotecan In The Treatment Of Small Cell Lung Cancer: A Systematic Review

Objective To evaluate the role of topotecan in the treatment of small cell lung cancer by considering the clinical efficacy and safety in clinical studies, its role in first and second line treatment, different administration formulations (dosage, route, schedule), toxicity and adverse effect.Methods The Cochrane Library, Medline,Embase,Cancerlit,CBM,CNKI and VIP were searched,so as hand-search and additional search.The quality of included studies was evaluated and meta-analysis was performed for the results of homogeneous studies.Results Forteen studies involving 2099 participants with small cell lung cancer.All included studies were adequate in reporting randomization,while inadequate in concealment of allocation and blinding.Meta-analysis based on included studies showed that response rate of TP regimen has no statistic significance compared with EP regimen[OR0.83,95%CI(0.63-1.090)],but myelo-suppression such as leucopenia and thrombopenia is more severe; response rate of single topotecan has no statistic significance compared with CE regimen[OR0.59,95%CI(0.22-1.60)]; response rate of TEP regimen has no statistic significance compared with EP regimen [OR1.37, 95%CI(0.82-2.28)], but myelo-suppression such as leucopenia, thrombopenia and anemia is more severe; response rate of IV topotecan has no statistic significance compared with Oral topotecan[OR0.97, 95%CI(0.60-1.57)],so as median time to progression[WMD-2.32, 95%CI( -5.72,1.09)] and median survival time[WMD-1.65, 95%CI(-7.13,3.83)],while neutropenia is more sever in IV topotecan than Oral topotecan. 45 treat-related deaths were reported in all included studies.Conclutions Topotecan is an effective remedy for treatment of small cell lung cancer, both single topotecan and combined regimen has the same effect as the traditional first-line regimen, though myelo-suppression such as leucopenia and thrombopenia is more sever, the adverse effect is tolerated. Though it has been recommended as second-line agent for chemo-therapy sensitive small cell lung cancer, there needs more clinical studies to verify its role in first-line. Oral topotecan shows certain advantage over IV topotecan. Due to high risk of selection bias and detection bias of included studies, the evidence is not strong enough to judge the effect of topotecan. Our results suggest that further and larger-scale trials of the use of topotecan will be carried in the treatment of small cell lung cancer.