Oral topotecan is recommended as a possible treatment for people with relapsed small-cell lung cancer if:
- re-treatment with the previous treatment is not considered appropriate and
- there is a medical reason why they cannot take the combination of cyclophosphamide, doxorubicin and vincristine (CAV).
Intravenous topotecan is not recommended for people with relapsed small-cell lung cancer.
Healthcare professionals should not stop prescribing topotecan for people with relapsed small-cell lung cancer who were already taking it when the guidance was issued. These people should be able to carry on taking topotecan until they and their specialist decide that it is the right time to stop treatment.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.