Chemotherapy in Addition to Supportive Care Improves Survival in Advanced Non–Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis of Individual Patient Data From 16 Randomized Controlled Trials

Abstract

A B S T R A C T PurposeSince our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non-small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. MethodsSystematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). ResultsData were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95% CI, 0.71 to 0.83; P Յ .0001), equivalent to a relative increase in survival of 23% or an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29%. There was no clear evidence that this effect was influenced by the drugs used (P ϭ .63) or whether they were used as single agents or in combination (P ϭ .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P ϭ .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. ConclusionThis MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.

Systemic inflammatory status at baseline predicts bevacizumab benefit in advanced non-small cell lung cancer patients

“…Standard treatment of advanced disease is based on the combination of a platinum-derivative with a second drug such as gemcitabine, paclitaxel, pemetrexed, docetaxel or vinorelbine. [1][2][3][4][5] Advanced NSCLC patients however, despite the treatment, have a median overall survival (OS) of about 10 mo. 6 More recently, the efficacy of standard combination chemotherapy has been improved by the introduction Bevacizumab is a humanized anti-VeGF monoclonal antibody able to produce clinical benefit in advanced non-squamous non-small cell lung cancer (nsCLC) patients when combined to chemotherapy.…”

Advances in the prevention and treatment of lung cancer

“…66,67 Recent data from a phase III trial suggest that cisplatin plus pemetrexed has a survival advantage over cisplatin plus gemcitabine for NSCLC with non-squamous histology. 68 Second-line chemotherapy is increasingly used for patients of good performance status.…”

Third-Line Therapy for Advanced Non-Small-Cell Lung Cancer Patients: A Feasible Therapeutic Option?

“…This meta-analysis showed that chemotherapy significantly improved patients’ quality of life (QoL) and median overall survival (OS) by 1.5 months as compared to best supportive care (BSC). More recently, a second meta-analysis has been published including individual data from 2,714 patients treated also with third-generation drugs in 16 randomized clinical trials confirming a survival advantage of 1.5 months for chemotherapy as compared to BSC alone [5]. In the last two decades several randomized studies compared third-generation platinum-based doublets showing that front-line regimens have reached a plateau for clinical efficacy differing mainly for their toxicity profiles and convenience [6].…”