In a recently reported phase II study, second-line topoisomerase inhibition with topotecan (4 mg/m2 weekly) combined with the VEGF inhibitor ziv-aflibercept (6 mg/kg every 21 days) improved the 3-month progression-free survival (PFS) of patients with platinum-resistant small-cell lung cancer (SCLC), compared with patients with platinum-sensitive SCLC (27% versus 10%, P = 0.02). Combination therapy also improved the disease control rate compared with topotecan alone in patients with platinum-resistant SCLC (24% for combination versus 15% for topotecan, P = 0.05) and in platinum-sensitive patients, although not reaching statistical significance in the latter (25% versus 15%, P = 0.14). The median PFS and overall survival rates were similar across both groups of patients.