A Randomized Phase II Study of Irinotecan/Cisplatin With or Without Simvastatin in Chemo-naive Patients With Extensive Disease-small Cell Lung Cancer
Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) have been used to treat
hypercholesterolemia. Besides the lipid lowering effects, they also act as anti-inflammatory
and anti-cancer agents. Recently the investigators demonstrated a synergistic cytotoxicity
between Simvastatin and Irinotecan in human lung cancer cells. Simvastatin enhances
Irinotecan-induced apoptosis by inhibition of proteasome activity. All of these additional
actions may counteract harmful effects of smoking-induced chronic inflammation. These
properties together with a high safety profile have made Statins more attractive drug for
small cell lung cancer (SCLC), the highly smoking-related cancer.
Given the promising preclinical anti-tumor and anti-inflammatory effects of Simvastatin in
SCLC, recently the investigators conducted a phase II study of Simvastatin and
Irinotecan/Cisplatin (IP) chemotherapy in chemo-naïve- patients with Extensive disease-small
cell lung cancer (ED-SCLC). The 1-year survival rate was 39.3%. The median overall survival
(OS) and progression free survival (PFS) was 11.0 months and 6.1 months, respectively.
Overall relative risk (RR) was 75%. The most common toxicity was neutropenia (67%). The
efficacy was significantly associated with smoking-status. Compared with never-smokers,
ever-smokers had higher RR (40% v 78%, P=0.01) and longer PFS (2.5 months v 6.4 months,
P=0.018) and showed a trend toward improved OS (9.0 months v 11.2 months, P=0.095). The
effect of smoking on survival was apparent when subdividing ever smokers according to
pack-years (PY). Ever-smokers who smoked > 65 PY showed significantly longer OS compared to
ever-smokers who smoked <= 65 PY or never-smokers (20.6 months v 10.6 months v 9.0 months,
log-rank P=0.032). In multivariate analysis, PY > 65 was predictive for longer survival
(hazard ratio) HR=0.377 [95% CI (confidence interval), 0.157-0.905]). These findings suggest
that the addition of Simvastatin to Irinotecan and Cisplatin improved efficacy in
ever-smokers with ED-SCLC. The survival benefit of this combination seems apparent in
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
1-year survival rate
Survival time will be calculated from the date of study treatment start to the date of death.( or date last seen ) Follow - up visits are conducted every 8 weeks to obtain meaningful data on time- to event variables. Assessment will continue until death or 12 months after treatment.
every 8 weeks
JI-YOUN HAN, M.D. PhD.
National Cancer Center
South Korea: Korea Food and Drug Administration (KFDA)