Thriving where others have faltered—a critical appraisal of the role of patient factors versus treatment effect in JCOG0605 trial in relapsed small cell lung cancer

Small cell lung cancer (SCLC) makes up approximately 13–15% of all lung cancer cases (1). Despite initial response to treatment, a large majority of patients with extensive stage SCLC relapse within 6 months (2). Improved outcome for SCLC patients remains stunted in major part because of lack of effective therapies for progressive disease following frontline therapy. Topotecan is the only salvage therapy with worldwide approval but its efficacy is quite modest and may be ineffective in patients with platinum insensitive disease (3-5). Contemporary comparative phase III studies of cytotoxic agents such as cabazitaxel and amrubicin against topotecan for relapsed SCLC have been negative especially in Western patient populations (6,7). It is therefore intriguing and interesting to observe that the randomized phase III JCOG0605 trial recently reported by Goto et al. showed an impressive benefit of the combination of cisplatin, etoposide and irinotecan, which significantly outperformed topotecan as second line therapy for patients with sensitive relapsed SCLC (8).