Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials

Abstract

Objective: To evaluate the effect of cytotoxic chemotherapy on survival in patients with non-small cell lung cancer. Design: Meta-analysis using updated data on individual patients from all available randomised trials, both published and unpublished. Subjects: 9387 patients (7151 deaths) from 52 randomised clinical trials. Main outcome measure: Survival. Results: The results for modern regimens containing cisplatin favoured chemotherapy in all comparisons and reached conventional levels of significance when used with radical radiotherapy and with supportive care. Trials comparing surgery with surgery plus chemotherapy gave a hazard ratio of 0.87 (13% reduction in the risk of death, equivalent to an absolute benefit of 5% at five years). Trials comparing radical radiotherapy with radical radiotherapy plus chemotherapy gave a hazard ratio of 0.87 (13% reduction in the risk of death; absolute benefit of 4% at two years), and trials comparing supportive care with supportive care plus chemotherapy 0.73 (27% reduction in the risk of death; 10% improvement in survival at one year). The essential drugs needed to achieve these effects were not identified. No difference in the si Conclusion: At the outset of this meta-analysis there was considerable pessimism about the role of chemotherapy in non-small cell lung cancer. These results offer hope of progress and suggest that chemotherapy may have a role in treating this disease.

Adjuvant Chemotherapy of Gemcitabine plus Carboplatin versus Paclitaxel plus Carboplatin in Patients with Resected Non-Small Cell Lung Cancer

“…Meta-analysis of the randomized trials of adjuvant therapy of NSCLC in 1995 suggested the survival benefit of cisplatin-based chemotherapy after surgery [4]. From the meta-analysis using 9387 patients (7151 deaths) from 52 randomized clinical trials, trials comparing surgery with surgery plus chemotherapy gave a hazard ratio of 0.87 (13% reduction in the risk of death, equivalent to an absolute benefit of 5% at five years).…”

“…From the meta-analysis using 9387 patients (7151 deaths) from 52 randomized clinical trials, trials comparing surgery with surgery plus chemotherapy gave a hazard ratio of 0.87 (13% reduction in the risk of death, equivalent to an absolute benefit of 5% at five years). However, there are no statistical differences between the postoperative adjuvant group and surgery alone [4], and this includes a number of small trials and trials with the following disability criteria and chemotherapy regimens. After the above-mentioned meta-analysis by the Nonsmall Cell Lung Cancer Collaborative Group, several clinical trials examining the adjuvant chemotherapy were performed, but the efficacy of adjuvant chemotherapy remained a matter of controversy.…”

“…A meta-analysis of small randomized trials of patients with early stage NSCLC in the preceeding 30 years was performed in 1995 [4]. This analysis revealed a 5% survival advantage at 5 years for patients with surgically resected early stage NSCLC treated with cisplatin-based chemotherapy compared to those patients only followed up after resection.…”

“…The presence of micrometastatic disease at the time of resection is the most likely cause of recurrence occurring even after complete resection of all the macroscopically recognizable lesions. If micrometastases are indeed responsible for the disease recurrence, adjuvant chemotherapy would be a rational treatment, and this hypothesis has led to the attempt to reduce the risk of relapse and death from lung cancer by giving adjuvant chemotherapy to patients with complete surgical resection [4].…”

Monoclonal Antibodies: An Emerging Class of Therapeutics in Non Small Cell Lung Cancer

“…The combination modality chemotherapy and radiotherapy conferred a small but significant survival advantage over radiotherapy alone in NSCLC [94]. Concomitant cetuximab and radiotherapy prolonged the survival of patients with locally advanced squamous cell carcinoma of the head and neck better than radiotherapy alone [95].…”