Impact of Primary Ambulatory Thromboprophylaxis (PATP) with Low-Molecular Weight Heparins (LMWHs) on Survival in Patients with Locally Advanced or Metastatic Lung Cancer (LC) Receiving Chemotherapy

Introduction: LC is the leading cause of cancer mortality in USA. PATP was provided in experimental trials to decrease the venous thromboembolism (VTE) rates and to provide anti-tumor effect with ultimate aim to improve survival in patients with solid cancers as VTE is the second leading cause of death in cancer patients. We undertook a systematic review and meta- analysis of randomized controlled trials (RCTs) to determine the impact of PATP with LMWHs on overall survival (OS) in patients with locally advanced or metastatic LC. Methods: We performed a comprehensive literature search using MEDLINE and EMBASE databases through July 26, 2019. The references of all potential studies were also reviewed for any additional relevant studies. RCTs utilizing PATP with LMWHs in patients with locally advanced or metastatic lung cancer were incorporated in the analysis. A generic inverse variance method was used to calculate the estimated pooled hazard ratio (HR) for progression or metastasis free survival and OS with 95% confidence interval (CI). Heterogeneity was assessed with Cochran's Q -statistic. Random effects model was applied. Results: A total of 3,452 patients with lung cancer from six RCTs were included in our meta-analysis. The prophylactic doses of bemiparin, dalteparin, tinzaparin, nadroparin and intermediate dose of enoxaparin were used in the studies. The duration of LMWH ranged from 3 to 6 months. The randomization ratio was 1 to 1 in all studies. The I2statistic for heterogeneity was 64, suggesting moderate heterogeneity among RCTs. The pooled HR for OS was not statistically significant at 1.02 (95% CI: 0.83-1.26; P = 0.83). In a subset of small cell lung cancer (SCLC) patients, the pooled HR for OS was 1.03 (95% CI: 0.72-1.48; P = 0.85). The HR for OS was noted at 1.70 (95% CI: 0.70-4.15; P = 0.24) in patients with limited stage SCLC. In a subset of non-small cell lung cancer, the pooled HR of OS was 1.00 (95% CI: 0.79-1.26; P = 0.98). The pooled HR for progression or metastasis free survivalwas 1.03 (95% CI: 0.86-1.24; P = 0.74) according to an analysis of 5 RCTs. Conclusions: Our meta- analysis demonstrated that no survival advantage was noted with the addition of PATP with LMWHs to routine standard chemotherapy in patients with locally advanced or metastatic LC, regardless of histology types as well as stages of SCLC. Disclosures Oo: Medical Education Speakers Network: Honoraria; Janssen and Janssen: Other: Research: site co-investigator .

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A1-05: Concomitant radio-chemotherapy (RT-CT) versus sequential RT-CT in locally advanced non-small cell lung cancer (NSCLC): A meta-analysis using individual patient data (IPD) from randomised clinical trials (RCTs)

Journal of Thoracic Oncology ◽

10.1097/01.jto.0000283094.86594.8f ◽

2007 ◽

Vol 2 (8) ◽

pp. S310 ◽

Cited By ~ 41

Author(s):

Anne Auperin ◽

Estelle Rolland ◽

Walter J. Curran ◽

Kiyoyuki Furuse ◽

Pierre Fournel ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Trials ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Individual Patient Data ◽

Meta Analysis ◽

Locally Advanced ◽

Small Cell ◽

Small Cell Lung ◽

Radio Chemotherapy

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Efficacy and Toxicity of Different Concurrent Chemoradiotherapy Regimens in Patients With Locally Advanced Non-Small Cell Lung Cancer-a Network Meta-Analysis

10.21203/rs.3.rs-531208/v1 ◽

2021 ◽

Author(s):

Qiang-qiang Zheng ◽

Shi-hui Min ◽

Qing-hua Zhou

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Concurrent Chemoradiotherapy ◽

Meta Analysis ◽

Locally Advanced ◽

Indirect Evidence ◽

Small Cell ◽

Cochrane Central Register ◽

Small Cell Lung

Abstract Background: Concurrent chemoradiotherapy (CCRT) is the cornerstone treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). The aim of this study was to compare the efficacy and toxicity of different CCRT regimens in the treatment of LA-NSCLC by adopting a network meta-analysis.Methods: PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were exhaustively searched to identify relevant studies from inception up to October 1, 2020. Direct and indirect evidence were combined to calculate the odds radio (OR) and its 95% confidence interval (CI), as well as to draw the surface under the cumulative ranking (SUCRA) curves. Cluster analyses were adopted to compare efficacy and toxicity of different CCRT regimens according to the similarity of 2 variables. Publication bias was detected by comparison-adjusted funnel plot.Results: Twenty-two studies were enrolled in this network meta-analysis, including 18 CCRT regimens: CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+carboplatin), CCRT (pemetrexed+cisplatin), CCRT (docetaxel+cisplatin), CCRT (S-1+cisplatin), CCRT (mitomycin+vindesine+cisplatin), CCRT (cisplatin+vinorelbine), CCRT (cisplatin), CCRT (etoposide+cisplatin+amifostine), RT, CCRT (5-FU), CCRT (paclitaxel+cisplatin), CCRT (irinotecan+carboplatin), CCRT (nedaplatin), CCRT (carboplatin+etoposide), CCRT (paclitaxel), and CCRT (carboplatin). The results indicated that the regimens with CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), CCRT (S-1+cisplatin), and CCRT (cisplatin+vinorelbine) had relatively better efficacy compared with other regimens. As for toxicity of different CCRT regimens, the CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), and CCRT (docetaxel+cisplatin) were relatively lower.Conclusions: Our study demonstrated that CCRT (pemetrexed+cisplatin) and CCRT (carboplatin+paclitaxel) might be the best choice of CCRT regimens in the treatment of LA-NSCLC, and the 3-year overall survival (OS) rate of CCRT (pemetrexed+cisplatin) was the highest among these regimens.

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The Impact of Skip vs. Non-Skip N2 Lymph Node Metastasis on the Prognosis of Non-Small-Cell Lung Cancer: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.749156 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xinxin Wang ◽

Haixie Guo ◽

Quanteng Hu ◽

Yongquan Ying ◽

Baofu Chen

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Lymph Node Metastases ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung ◽

Node Metastases ◽

The Impact

Objective: The skip N2 metastases were frequent in non-small-cell lung cancer (NSCLC) and the better prognosis of NSCLC with a skip over non-skip N2 lymph node metastases is controversial. The primary aim of this study is to investigate the prognosis effect of skip N2 lymph node metastases on the survival of NSCLC.Setting: A literature search was conducted in PubMed, EMBASE, and Cochrane Library with the term of “N2” or “mediastinal lymph node” or “mediastinal nodal metastases”, and “lung cancer” and “skip” or “skipping” in the title/abstract field. The primary outcomes of interests are 3- and 5-year survival in NSCLC.Participants: Patients who underwent complete resection by lobectomy, bilobectomy, or pneumonectomy with systemic ipsilateral lymphadenectomy and were staged as pathologically N2 were included.Primary and Secondary Outcome Measures: The 3- and 5-year survival of NSCLC was analyzed. The impact of publication year, number of patients, baseline mean age, gender, histology, adjuvant therapy, number of skip N2 stations, and survival analysis methods on the primary outcome were also analyzed.Results: A total of 21 of 409 studies with 6,806 patients met the inclusion criteria and were finally included for the analysis. The skip N2 lymph node metastases NSCLC had a significantly better overall survival (OS) than the non-skip N2 NSCLC [hazard ratio (HR), 0.71; 95% CI, 0.62–0.82; P < 0.001; I2 = 40.4%]. The skip N2 lymph node metastases NSCLC had significantly higher 3- and 5-year survival rates than the non-skip N2 lymph node metastases NSCLC (OR, 0.75; 95% CI, 0.66–0.84; P < 0.001; I2 = 60%; and OR, 0.78; 95% CI, 0.71–0.86; P < 0.001; I2 = 67.1%, respectively).Conclusion: This meta-analysis suggests that the prognosis of skip N2 lymph node metastases NSCLC is better than that of a non-skip N2 lymph node.

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The Impact of Afatinib on Survival in Advanced Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials

Journal of Cancer ◽

10.7150/jca.27528 ◽

2019 ◽

Vol 10 (4) ◽

pp. 885-892

Author(s):

Chi Wang ◽

Yun Li ◽

Li Ke ◽

Lejie Cao ◽

Pingsheng Fan ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Randomized Controlled Trials ◽

Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Controlled Trials ◽

Small Cell Lung ◽

Randomized Controlled ◽

The Impact

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Impact of Extended-Interval Versus Standard Dosing of Zoledronic Acid on Skeletal Events in Non–Small-Cell Lung Cancer and Small-Cell Lung Cancer Patients With Bone Metastases

Annals of Pharmacotherapy ◽

10.1177/1060028020967629 ◽

2020 ◽

pp. 106002802096762

Author(s):

Andrew H. Tam ◽

Allison J. Schepers ◽

Angel Qin ◽

Victoria R. Nachar

Keyword(s):

Lung Cancer ◽

Zoledronic Acid ◽

Small Cell Lung Cancer ◽

Bone Metastases ◽

Cell Lung Cancer ◽

Small Cell ◽

Metastatic Lung Cancer ◽

Small Cell Lung ◽

Lung Cancer Patients ◽

Metastatic Lung

Background: Zoledronic acid every 4 weeks (Q4wk) reduces the incidence of skeletal-related events (SREs) in patients with metastatic lung cancer. Lung cancer patients were excluded from extended-interval dosing trials (every 12 weeks [Q12wk]) that demonstrated noninferiority of the 2 dosing schemes. To date, the optimal dosing of zoledronic acid in metastatic lung cancer remains unknown. Objective: To determine whether zoledronic acid dosed Q12wk is similar to Q4wk dosing for prevention of SRE in patients with metastatic lung cancer. Methods: A retrospective analysis was performed in patients with non–small-cell lung cancer and small-cell lung cancer with bone metastases who received Q12wk and Q4wk zoledronic acid. The primary outcome was incidence of SRE at 1 year. Secondary analyses included time to first SRE, overall survival (OS), incidence of osteonecrosis of the jaw (ONJ), kidney dysfunction, and hypocalcemia. Results: A total of 34 patients received Q12wk and 46 patients received Q4wk zoledronic acid. Incidence of SRE at 1 year (Q12wk, 23.5%, vs Q4wk, 23.9%; 95% CI = −0.184 to 0.192; P = 0.968) and median time to SRE (not reached for either cohort; P = 0.530) did not differ. The Q12wk cohort had longer median OS (24.00 vs 8.97 months; P = 0.022). There were no differences in incidence of ONJ, kidney dysfunction, and hypocalcemia. Conclusion and Relevance: This is the first report examining extended-interval dosing of zoledronic acid in metastatic lung cancer. Incidence and time to SRE at 1 year were similar. This extended-interval dosing may be safe and reasonable for patients with lung cancer with bone metastases.

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