The correlates of benefit from neoadjuvant chemotherapy before surgery in non-small-cell lung cancer: a metaregression analysis

Abstract

BackgroundAlthough neoadjuvant chemotherapy (NCT) is widely used, it is not clear which subgroup of locally advanced non-small-cell lung cancer (NSCLC) patients should be treated with this approach, and if a particular benefit associated with NCT exists. In this study, we aimed to investigate the potential correlates of benefit from NCT in patients with NSCLC.MethodsAll randomized clinical trials (RCTs) utilizing a NCT arm (without radiotherapy) versus a control arm before surgery were included for metaregression analysis. All regression analyses were weighed for trial size. Separate analyses were conducted for trials recruiting patients with different stages of disease. Previously published measures of treatment efficacy were used for the purpose of this study, regardless of being published in full text or abstract form.ResultsA total of 14 RCTs, consisting of 3,615 patients, were selected. Histology, stage, various characteristics of the NCT protocol, and different trial features including trial quality score were not associated with the benefit of NCT. However, in trials of stage 3 disease only, there was a greater benefit in terms of reduction in mortality from NCT, if protocols with three chemotherapeutics were used (B = −0.18, t = −5.25, P = 0.006).ConclusionsWe think that patients with stage 3 NSCLC are served better with NCT before surgery if protocols with three chemotherapy agents or equally effective combinations are used. In addition, the effect of neoadjuvant chemotherapy is consistent with regard to disease and patient characteristics. This finding should be tested in future RCTs or individual patient data meta-analyses.

Neoadjuvant therapy and risk of bronchopleural fistula after lung cancer surgery: a systematic meta-analysis of 14 912 patients

“…NT can reduce or eliminate the micro-metastasis especially in patients with advanced lung cancer (4,5). Recent systematic reviews have integrated the previously published randomized control trials (RCTs) and concluded that NT can significantly benefit the survival outcomes of operable patients (4)(5)(6). However, the impact of NT on intraoperative and postoperative complications still remains a debate (7,8).…”

“…Recently, the statistical methods of evidence-based medicine (EBM) which are represented by meta-analyses, have been increasingly applied in clinical practice to draw relatively global conclusions by quantitatively integrating the appropriate data from homogeneous studies (4)(5)(6)14). The current evidences revealing the effects of NT on BPF risk have not yet been systematically reviewed.…”

New basic approach to treat non‐small cell lung cancer based on RNA‐interference

“…Now there are new treatment options, especially for patients in advanced stages. For example, preoperative chemotherapy or the tyrosine‐kinase inhibitor erlotinib can be used in some patients to prolong survival …”

Neoadjuvant chemotherapy followed by surgery versus upfront surgery in non-metastatic non-small cell lung cancer: systematic review and meta-analysis of randomized controlled trials

“…Adjuvant chemotherapy following surgically resected (Stage IB (> 4 cm)-IIIA) NSCLC is now considered the standard of care, but the neoadjuvant setting is less well established. Neoadjuvant chemotherapy (NAC), which is defined as chemotherapy applied before surgery, has been investigated by various trials [ 8 – 18 ] and systematic reviews [ 19 , 20 ], with controversial results; some reported survival benefit with improved resection rate and micro-metastasis control. Since many of the studies included in the previous meta-analyses [ 19 , 20 ] were non-randomized small-scale trials, the results were unconvincing with biases.…”