Duration of chemotherapy for advanced non-small cell lung cancer: An updated systematic review and meta-analysis

Dramatic complete response in patient with lung adenocarcinoma

“…Response rates in advanced NSCLC to chemotherapy combination regimens are around 20% and one-year survival is less than 35% % [1][2][3][4].…”

Update on nonsmall cell lung cancer

“…In the meta-analysis by SOON and co-workers [87,88] that included the JMEN study plus 13 other randomised trials (but not SATURN or the ATLAS trials), and collected data on 1,684 patients with maintenance and 1,395 without, maintenance therapy was shown to slightly, but significantly, improve OS (HR 0.92, 95% CI 0.86-0.99; p50.03), pleading for a new paradigm in NSCLC treatment.…”

Potential Treatment Options After First-Line Chemotherapy for Advanced NSCLC: Maintenance Treatment or Early Second-Line?

“…At the last ASCO meeting, Soon et al [34] presented a systematic review and meta-analysis of published randomized controlled trials evaluating longer versus shorter durations of chemotherapy. Those authors included, in this analysis, randomized trials assessing: (a) a defined number of cycles of chemotherapy versus continuing until disease progression, (b) a defined number of cycles versus a higher number of cycles of the same chemotherapy, and (c) a defined number of cycles of initial chemotherapy versus the same initial chemotherapy followed by additional cycles of a different chemotherapy.…”

“…The authors concluded that continuing third-generation chemotherapy beyond three or four cycles resulted in a significantly longer progression-free survival time but not overall survival time, and produced more adverse events. However, in un update presented at the last ASCO meeting, Soon et al [34] updated the data, including the results of the trial of Ciuleanu et al [28] on maintenance treatment with pemetrexed. Considering these data, Soon et al [34] showed a statistically significant benefit in terms of overall survival (HR, 0.92; 95% CI, 0.86 -0.99; p ϭ .03) in favor of prolonged chemotherapy, but this delayed adjunct of data to the original meta-analysis presents a methodological issue.…”

“…However, in un update presented at the last ASCO meeting, Soon et al [34] updated the data, including the results of the trial of Ciuleanu et al [28] on maintenance treatment with pemetrexed. Considering these data, Soon et al [34] showed a statistically significant benefit in terms of overall survival (HR, 0.92; 95% CI, 0.86 -0.99; p ϭ .03) in favor of prolonged chemotherapy, but this delayed adjunct of data to the original meta-analysis presents a methodological issue. However, in the near future we should separately analyze maintenance therapy with the same agents used in the induction phase from early second-line therapy or consolidation therapy.…”