Phase II Trial of Oral Topotecan and Paclitaxel With G-CSF (Filgrastim) Support in Patients With Previously Untreated Extensive-Stage Small Cell Lung Cancer

Inclusion Criteria

DISEASE CHARACTERISTICS: Histologically or cytologically confirmed previously untreated
small cell lung cancer No mixed histology Extensive disease Metastatic disease outside the
chest Contralateral supraclavicular nodes or contralateral hilar nodes outside a single
radiation port OR Cytologically proven malignant pleural effusion Measurable or evaluable
disease No untreated CNS metastases CNS metastases previously treated with whole brain
radiotherapy allowed

PATIENT CHARACTERISTICS: Age: 18 and over Performance status: ECOG 0-2 Life expectancy:
Not specified Hematopoietic: Absolute neutrophil count at least 1,500/mm3 Platelet count
at least 100,000/mm3 Hepatic: AST no greater than 5 times upper limit of normal (ULN)
Alkaline phosphatase no greater than 5 times ULN Total bilirubin no greater than 1.5 times
ULN OR Direct bilirubin normal Renal: Creatinine no greater than ULN OR Creatinine
clearance at least 50 mL/min Cardiovascular: No uncontrolled angina pectoris No congestive
heart failure within the past 3 months, unless ejection fraction greater than 40% No
uncontrolled arrhythmias No myocardial infarction within the past 3 months Other: No
significant infection No hypersensitivity to E. coli derivatives No other malignancy
within the past 3 years except nonmelanoma skin cancer, carcinoma in situ of the cervix,
or localized prostate cancer Not pregnant or nursing Fertile patients must use effective
contraception

PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: At least 10 years
since prior chemotherapy No prior nitrosourea based chemotherapy Endocrine therapy: Not
specified Radiotherapy: See Disease Characteristics At least 10 years since prior thoracic
radiotherapy No more than 3 fractions of prior thoracic radiotherapy for superior vena
cava syndrome Prior palliative radiotherapy except to the chest allowed No prior
radiotherapy to at least 20% bone marrow No concurrent radiotherapy (including thoracic),
except whole brain radiotherapy for CNS progression Surgery: At least 3 weeks since prior
major surgery