Randomized Comparison With

Souhami et al. (1) recently reported that single-agent oral etoposide could not be recommended to patients with small-cell lung cancer (SCLC). In accor-dance with their results and also the U.K. Medical Research Council trial (2), we report the results of a Danish ran-domized study that was terminated early. This decision was based on an in-terim analysis demonstrating that pro-longed, low-dose, oral etoposide pro-duced inferior results compared with a combination of intravenous carboplatin and oral etoposide. The cytotoxic action of etoposide is schedule dependent (3); therefore, eto-poside is frequently administered daily for 3 or 5 consecutive days. Moreover, several phase II trials have indicated that continuous, daily, oral etoposide might improve efficacy with minor toxicity in patients with SCLC (4). The primary aim of antineoplastic therapy for patients with extensive SCLC is to palliate symptoms. Never-theless, antineoplastic therapy prolongs median survival time from 2 months to 7–9 months. No standard cytotoxic therapy exists, but the combination of carboplatin and etoposide or the addi-tion of etoposide to well-known combi-nations produces results that are compa-rable to those obtained with other regimens (5,6). The aim of our study was to investi-gate whether single-agent, daily, oral etoposide is an effective, low-toxic, pal-liative therapy compared with combina-tion therapy. The bioavailability of oral etoposide (150–300 mg/m2) is about 50 % (range, 25%-75%); however, when etoposide is administered as a continuous, low dose, the bioavailability is approximately 90% (7,8). Accordingly, a dose of 50 mg/day for 14 days might be comparable to an oral dose of 240 mg/m2 for 3 days. On the basis of these assumptions