Meta-Analysis of Single-Agent Chemotherapy Compared With Combination Chemotherapy As Second-Line Treatment of Advanced Non–Small-Cell Lung Cancer

Maïo, Massimo Di; Chiodini, Paolo; Georgoulias, Vassilis; Hatzidaki, Dora; Takeda, Koji; Wachters, Floris M; Gebbia, Vittorio; Smit, Egbert F.; Morabito, Alessandro; Gallo, Ciro; Perrone, Francesco; Gridelli, Cesare

doi:10.1200/jco.2008.17.5844

Cited by 153 publications

(94 citation statements)

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“…The multivariate analysis in this study showed that patients with stage IV disease had a higher risk for death than stage IIIb which is consistent with other studies, whereas the initial clinical stage affects the success of second-line chemotherapy 11,14 . From our study we observed that patients who had received platinum based as first-line treatment followed by taxanes containing regimen as second-line treatment had a better prognosis than others.…”

Section: Discussionsupporting

confidence: 80%

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Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

Attia

Ibrahim

Talima

et al. 2017

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Background: Lung cancer is the leading cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for 80-85 %. Methods: In this retrospective hospital based study, 424 NSCLC patients "stage IIIb-IV" were enrolled to analyze the prognostic factors and survival after receiving second-line chemotherapy. Results: From 424 NSCLC patients, 236 (55.7%) had stage IIIb-IV disease. The majority (70%, 165/236) of these patients received best supportive care only and 30% (71/236) received first-line chemotherapy. Second-line chemotherapy was administered in 11.9% (28/236) patients after first-line chemotherapy. The median age of patients who received secondline was 58 years. The majority were males (64%). Sixty four percent had stage IV, 57% had an Eastern Cooperative Oncology Group (ECOG) performance status of 2-3, 72% had a body mass index of >18.5 kg/m 2 and 57% had history of smoking. The median overall survival was 13 months (95% CI: 6.82-19.18). The first-line chemotherapy was platinumbased combination in all patients, and docetaxel was the second-line treatment in half of the patient. The most common side effects were hematological (93%) and gastrointestinal (78%). Higher risk of mortality was accompanied with age 40-60 years (HR: 5.53, 95% CI: 1.29-23.7, p = 0.022) and stage IV (HR: 3.65, 95% CI: 1.21-11.06, p = 0.022). Multivariate analysis revealed that stage IV had higher risk of mortality than stage IIIb (HR: 3.75, 95% CI 0.969-14.535, p = 0.056). The platinum-taxane combination added 3 months in the median survival (13 vs. 10 months, p = 0.4). Conclusion: Stage IV and age between 40-60 years had a higher risk of death in NSCLC.

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Section: Discussionsupporting

confidence: 80%

“…The poor prognosis of squamous histology and male gender agrees with Di Maio et al 11 , whereas patients with poor performance status, advanced clinical stage, poor response to first-line chemotherapy, were males and the non-adenocarcinoma histology had worse outcome.…”

Section: Discussionsupporting

confidence: 76%

Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

Attia

Ibrahim

Talima

et al. 2017

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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“…The doublet arms had significantly higher rates of both grade 3/4 hematologic (41% vs. 25%, p<0.0001) and non-hematologic (28% vs. 22%, p=0.034) toxicity. 12 Two additional meta-analyses assessing docetaxel alone versus docetaxel-based doublet chemotherapy and pemetrexed alone versus pemetrexed-based doublet chemotherapy demonstrated similar results. Both analyses showed improvements in RR and PFS with doublet chemotherapy but no improvement in OS.…”

Section: Single Agent Versus Combination Regimensmentioning

confidence: 91%

Second-Line Chemotherapy and Beyond for Non–Small Cell Lung Cancer

Durm

Hanna

2017

Hematology/Oncology Clinics of North America

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Keywordsnon-small cell lung cancer, chemotherapy, second-line treatment, docetaxel, pemetrexed, erlotinib Key Points• Docetaxel, pemetrexed, and erlotinib are approved for the second-line treatment of NSCLC.• The discovery of targetable mutations, the increasing use of maintenance strategies, and the introduction of immunotherapies has made the choice of second-line agents much more complicated.• Ramucirumab with docetaxel is the only combination regimen that has shown improved overall survival in the second-line setting.• Erlotinib is the only agent approved in the third-line setting for EGFR wild-type patients. First Line TreatmentIn patients without targetable genetic alterations, the standard first-line therapy for advanced (stage IIIB or IV) NSCLC is chemotherapy with a platinum doublet for 4-6 cycles with or without bevacizumab. 1 Historically, a number of drugs including paclitaxel, docetaxel, gemcitabine, and vinorelbine were considered acceptable platinum partners in the first-line metastatic setting with essentially no differences in progression free survival (PFS) or overall survival (OS). More recently, additional agents have been approved in combination with platinum in this setting including pemetrexed and nab-paclitaxel. [1][2][3] One particular advance in the last decade has been the recognition that histology should be considered in the choice of initial chemotherapy. This was discovered after an additional analysis of two studies showed pemetrexed to be more effective in non-squamous histologies and less active in squamous tumors. 3-5 Based on these findings, the choice of first-line agents in metastatic NSCLC is now strongly based on presenting histology, and this initial choice affects available second-line options. Maintenance TherapyHistorically, patients treated with first-line platinum doublet chemotherapy who had objective responses or stable disease were placed on surveillance following completion of 4-6 cycles. However, over the last decade, new data suggests that there is benefit to the addition of maintenance therapy following initial chemotherapy. There are two maintenance strategies including continuation of an agent used in the first-line setting or switching to a previously unused agent (switch maintenance). There is data supporting the use of bevacizumab, pemetrexed, and erlotinib in the maintenance setting either as single agents or in combination. [6][7][8][9][10][11] Prior maintenance therapy is of particular importance when discussing second-line chemotherapy options as the use of maintenance therapy, particularly when switch maintenance is employed, influences the availability of agents in the second-line setting and beyond. Chemotherapy as Second-Line TreatmentHistorically, nearly all patients received platinum doublet chemotherapy followed by single agent chemotherapy in the second-line setting. However, with the discovery of targetable mutations, the development of tyrosine kinase inhibitors (TKI), the increasing use of maintenance strategies, and the introduction of imm...

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“…Odpowiedź na chemioterapię II linii jest jednak krótka, i u większości chorych w ciągu kilku miesięcy dochodzi do ponownej progresji choroby. W leczeniu II linii stosuje się najczęściej pojedyncze leki, bowiem ich skuteczność mierzona czasem do progresji i czasem całkowitego przeżycia, jest podobna do uzyskiwanej przy użyciu wielolekowej chemioterapii [103,104].…”

Section: Chemioterapia II Liniiunclassified

Rola systemowych metod leczenia u chorych na niedrobnokomórkowego raka płuca i złośliwego międzybłoniaka opłucnej: Uaktualnione zalecenia ekspertów

Jassem

Biernat

Bryl

et al. 2014

Advances in Respiratory Medicine

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Rak płuca jest w Polsce najczęstszą przyczyną zgonów nowotworowych. Około 85% wszystkich nowotworów płuca stanowi rak niedrobnokomórkowy (NDRP), w którym leki cytotoksyczne i ukierunkowane molekularnie odgrywają coraz większą rolę. W pracy przedstawiono oparte na obecnej wiedzy zalecenia dotyczące stosowania tych metod w praktyce klinicznej u chorych na NDRP oraz na złośliwego międzybłoniaka opłucnej.

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Meta-Analysis of Single-Agent Chemotherapy Compared With Combination Chemotherapy As Second-Line Treatment of Advanced Non–Small-Cell Lung Cancer

Abstract: Doublet chemotherapy as second-line treatment of advanced NSCLC significantly increases response rate and progression-free survival, but is more toxic and does not improve overall survival compared to single-agent.

Cited by 153 publications

References 20 publications

Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

Second-Line Chemotherapy in Advanced Non-Small Cell Lung Cancer (NSCLC): Single Institution Experience

Second-Line Chemotherapy and Beyond for Non–Small Cell Lung Cancer

Rola systemowych metod leczenia u chorych na niedrobnokomórkowego raka płuca i złośliwego międzybłoniaka opłucnej: Uaktualnione zalecenia ekspertów

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