Can meta-analysis suggest carboplatin/paclitaxel as a reference arm in randomized trials of first-line chemotherapy for advanced non-small cell lung cancer?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19039-e19039
Author(s):  
T. Yamanaka ◽  
N. Yamamoto ◽  
T. Seto ◽  
T. Takahashi ◽  
H. Murakami ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Confidence Interval ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Line Chemotherapy

e19039 Background: The validity of adapting carboplatin/paclitaxel (CbP) as a reference arm in randomized trials of first-line chemotherapy for advanced non-small-cell lung cancer has not been fully evaluated. Methods: We performed a meta- analysis on trials identified through a literature search. The analysis included randomized trials comparing CbP with cisplatin-based third- generation (3G) regimens. Results: Of 160 articles screened, seven randomized trials were eligible for the analysis. The pooled hazard ratio (HR) for overall survival showed that CbP was not an inferior regimen to cisplatin-based 3G regimens (HR=1.04; 95% confidence interval, 0.96–1.13; p=0.296). On focusing on 3G agents other than vinorelbine, we observed a marginally significant improvement in survival with cisplatin-based regimens (HR=1.08; 95% confidence interval, 0.99–1.18; p=0.080). CbP generally involved a higher risk of thrombocytopenia and peripheral neuropathy but a lower risk of anemia, nausea, and toxic deaths. Conclusions: There is no evidence that CbP was significantly inferior to cisplatin-based 3G regimens in terms of efficacy. However, since CbP was less inclined to result in better survival, the preferred use of CbP as a reference arm in randomized trials instead of cisplatin-based 3G regimens may depend on the purpose of the trial. No significant financial relationships to disclose.

scholarly journals Systematic review of first-line chemotherapy for chemo-naïve extensive-stage small-cell lung cancer: network meta-analysis

2020 ◽  
Vol 12 ◽  
pp. 175883592096584 ◽  
Author(s):  
Hao Chen ◽  
Nobuyuki Horita ◽  
Kentaro Ito ◽  
Hideyuki Nagakura ◽  
Yu Hara ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Weighted Least Squares ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Line Chemotherapy

Background: Our goal was to organize the data from randomized controlled trials that evaluated first-line chemotherapy for chemo-naïve extensive disease small-cell lung cancer (ED-SCLC). Methods: The protocol following PRISMA methodology was submitted as PROSPERO 154049. We included individually randomized trials comparing two or more chemotherapy regimens as the first-line treatment for chemo-naïve ED-SCLC regardless of the age, sex, performance status, co-morbidities, and organ functions written in the English language since 2000. Molecular targeted agents and immune checkpoint inhibitors were considered chemotherapy along with cytotoxic medications. We pooled the logarithm of hazard ratio (HR) and its standard error using the frequentist weighted least squares approach random-model network meta-analysis. Results: A total of 46 eligible trials that involved 11,987 patients were included. The primary endpoint, HR of overall survival (OS, HRos) of the selected comparisons was as follows: carboplatin+amrubicin (HRos 0.56, 95% confidence interval (CI) 0.33–0.96), carboplatin+etoposide+atezolizumab (HRos 0.70, 95% CI 0.53–0.92), and carboplatin+irinotecan (HRos 0.73, 95% CI 0.58–0.91) were compared with carboplatin+etoposide. The carboplatin+etoposide+atezolizumab regimen was compared with carboplatin+irinotecan (HRos 0.97, 95% CI 0.68–1.37) and cisplatin+irinotecan regimen (HRos 0.87, 95% CI 0.58–1.31). “Selective carboplatin or cisplatin (CBDCA/CDDP)”+etoposide+durvalumab was compared with CBDCA/CDDP+etoposide (HRos 0.73, 95% CI 0.59–0.91). Platinum+etoposide+durvalumab was compared with platinum+irinotecan (HRos 0.88, 95% CI 0.67–1.15). Cumulative meta-analysis suggested that platinum+irinotecan was associated with better OS than platinum+etoposide as of 2010 through 40 out of 46 trials in our review that used platinum+etoposide as a reference regimen. Conclusion: Patients treated with carboplatin+amrubicin, carboplatin+etoposide+atezolizumab, CBDCA/CDDP+etoposide+durvalumab, and platinum+irinotecan showed better HRos than those treated with platinum+etoposide, one of the standard regimens.

Optimal duration of first-line chemotherapy for advanced non-small cell lung cancer: A systematic review with meta-analysis

2009 ◽  
Vol 45 (4) ◽  
pp. 601-607 ◽  
Author(s):  
João Paulo da Silveira Nogueira Lima ◽  
Lucas Vieira dos Santos ◽  
Emma Chen Sasse ◽  
Andre Deeke Sasse
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Optimal Duration ◽  
Line Chemotherapy

Weekly docetaxel as second line chemotherapy for advanced non-small-cell lung cancer: Meta-analysis of randomized trials

2006 ◽  
Vol 32 (8) ◽  
pp. 583-587 ◽  
Author(s):  
Emilio Bria ◽  
Federica Cuppone ◽  
Mariangela Ciccarese ◽  
Cecilia Nisticò ◽  
Francesco Facciolo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
Weekly Docetaxel ◽  
Line Chemotherapy

scholarly journals Adding PD-1/PD-L1 Inhibitors to Chemotherapy for the First-Line Treatment of Extensive Stage Small Cell Lung Cancer (SCLC): A Meta-Analysis of Randomized Trials

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2645 ◽  
Author(s):  
Francesco Facchinetti ◽  
Massimo Di Maio ◽  
Marcello Tiseo
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Small Cell ◽  
Survival Outcomes ◽  
Small Cell Lung ◽  
First Line ◽  
Extensive Stage

Survival outcomes in extensive-stage small cell lung cancer (ES SCLC) are dismal, with median overall survival (OS) less than 12 months. The combination of PD-1/PD-L1 immune checkpoint inhibitors (ICIs) with first-line platinum-etoposide chemotherapy has been recently evaluated in randomized clinical trials. We performed a systematic literature review through PubMed and conference proceedings. Randomized trials evaluating chemotherapy +/− PD-1/PD-L1 ICIs were included in the meta-analysis. Efficacy (OS), activity [progression-free survival (PFS) and objective response rate (ORR)] outcomes and toxicities were analyzed. For selected endpoints, we focused on patients’ subgroups (OS) and on landmark analyses (OS, PFS). Four randomized trials were identified; globally, 1553 patients were randomized to receive chemotherapy +/− PD-1/PD-L1 ICIs. Adding a PD-1/PD-L1 ICI to chemotherapy led to a significant benefit in OS [hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.68–0.85, p < 0.00001), PFS [HR 0.75, 95% CI 0.68–0.84, p < 0.00001] and ORR [odds ratio 1.28, 95% CI 1.04–1.57, p = 0.02]. No unexpected toxicity emerged. At 12, 18, 24 months for OS, and at 12, 18 months for PFS, experimental arms retained significant improvement in event-free rates, with absolute gain of approximately 10% compared with standard treatment. Albeit the magnitude of the benefit is less impacting compared to other settings of immunotherapy, the addition of PD-1/PD-L1 ICIs to chemotherapy in ES SCLC provided significant improvements in survival outcomes with the known toxicity profile. Biomarkers predicting which patients are suitable to derive long-term benefits are eagerly awaited.

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