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Link to original content: https://www.ncbi.nlm.nih.gov/pubmed/20464750
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Review
. 2010 May 12;2010(5):CD007309.
doi: 10.1002/14651858.CD007309.pub2.

Chemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer

Non-Small Cell Lung Cancer Collaborative Group  1
Affiliations
Review

Chemotherapy and supportive care versus supportive care alone for advanced non-small cell lung cancer

Non-Small Cell Lung Cancer Collaborative Group. Cochrane Database Syst Rev. .

Abstract

Background: Since our individual patient data (IPD) meta-analysis of supportive care and chemotherapy for non-small cell lung cancer (NSCLC), published in 1995, many trials have been completed. We have carried out an updated IPD meta-analysis to assess newer regimens and determine conclusively the effect of chemotherapy.

Objectives: To assess the effect on survival of supportive care and chemotherapy versus supportive care alone in advanced NSCLC.

Search strategy: All randomised controlled trials (RCTs), published or unpublished. We searched bibliographic databases, trials registers, conference proceedings and reference lists of relevant trials. Searches were completed to November 2009.

Selection criteria: Trials had to have commenced accrual on or after 1 January 1965 and should have included patients with NSCLC who had received either chemotherapy and supportive care or supportive care alone. Patients should have not received any previous chemotherapy or had any prior malignancy.

Data collection and analysis: For trials included in 1995 we sought updated follow up. For new trials we sought survival and baseline characteristics for all patients. We combined results from RCTs to calculate individual and pooled hazard ratios (HRs).

Main results: We obtained data on 2714 patients from 16 RCTs. There were 1293 deaths among 1399 patients assigned supportive care and chemotherapy and 1240 among 1315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR = 0.77; 95% CI 0.71 to 0.83, P < 0.0001), equivalent to a relative increase in survival of 23%, an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29% or an absolute increase in median survival of 1.5 months (from 4.5 months to six months). There was no clear evidence that this effect was influenced by the drugs used (P = 0.63) or whether they were used as single agents or in combination (P = 0.40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = 0.77). There was no clear evidence of a difference in the relative effect of chemotherapy across patient subgroups. Quality of life could not be formally assessed.

Authors' conclusions: All trials were of good methodological quality with no risk of bias. This meta-analysis of chemotherapy in the supportive care setting demonstrates that chemotherapy improves overall survival in all patients with advanced NSCLC. Patients who are fit enough and wish to receive it should be offered chemotherapy.

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Conflict of interest statement

No conflict of interest.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Simple (non‐stratified) Kaplan‐Meier curve for survival by treatment
3
3
Hazard ratio plot showing effect of chemotherapy on survival by age, sex, stage, histology and performance status
1.1
1.1. Analysis
Comparison 1 Chemotherapy and supportive care, Outcome 1 Overall survival.
See this image and copyright information in PMC

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  • doi: 10.1002/14651858.CD007309

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References

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