Maintenance chemotherapy in limited small cell lung cancer: a randomised controlled clinical trial

Abstract

Summary In a prospective randomised study 68

Practice guideline for the role of combination chemotherapy in the initial management of limited-stage small-cell lung cancer

“…There were 21 randomized trials, three published in abstract form, which compared at least two chemotherapy regimens for SCLC ; seven randomized trials involving at least one alternating chemotherapy regimen (i.e., trials in which two different chemotherapy combinations were delivered in an alternating sequence) [22,24,[28][29][30][31][32]; four randomized trials which compared schedules or routes of administration of etoposide or formulations of etoposide [33][34][35][36]; 14 trials comparing a standard regimen to a dose-intensive one [37][38][39][40][41][42][43][44][45][46][47][48][49][50]; and six trials of duration of chemotherapy [51][52][53][54][55][56]. Note that two trials [22,24] appear in two sets of comparisons.…”

“…Three of these trials detected no survival benefit to continued chemotherapy over observation following induction [51,52,54]. One trial, which enrolled only patients with limited-stage disease [53], detected a statistically significant survival disadvantage to maintenance chemotherapy. There are data indicating that maintenance therapy increases toxicity and/or worsens quality of life [52].…”

“…The trials differ with respect to the regimens used for both induction and maintenance chemotherapy, although most included thoracic radiotherapy between cycles of induction chemotherapy or following completion of induction chemotherapy [51][52][53]56]. In two trials, thoracic radiotherapy was not delivered [54,55].…”

“…In four randomized controlled trials, patients who responded to [51,52] or did not progress on [53,54] induction chemotherapy received maintenance chemotherapy or no additional chemotherapy. Three of these trials detected no survival benefit to continued chemotherapy over observation following induction [51,52,54].…”

“…Six randomized studies evaluating optimal duration of chemotherapy for patients with limited-stage SCLC are summarized in Table 5 [51][52][53][54][55][56]. The trials differ with respect to the regimens used for both induction and maintenance chemotherapy, although most included thoracic radiotherapy between cycles of induction chemotherapy or following completion of induction chemotherapy [51][52][53]56].…”