Third-generation chemotherapy agents in the treatment of advanced non-small cell lung cancer: A meta-analysis [2]
Year: 2021
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: Purpose: To estimate the efficacy of third-generation (3G) chemotherapy agents (paclitaxel, docetaxel, gemcitabine, vinorelbine, and irinotecan) on response and survival in stage IIIB/IV non-small cell lung cancer (NSCLC).Methods: A meta-analysis was performed using trials identified through MEDLINE.Results on tumor response and survival were collected from randomized trials comparing 3G monotherapy versus best supportive care (BSC), 3G monotherapy versus second-generation (2G) platinum-based regimens, and 3G platinum-based regimens versus 2G platinum-based regimens.Results: Of the 2480 citations screened, 20 randomized controlled trials fulfilled the inclusion and exclusion criteria, and 19 trials were used in the analyses.The data from two, three-arm trials were used in two different comparisons.Five trials (n ϭ 1029 patients) compared 3G monotherapy with BSC.The summary risk difference (RD) for 1-year survival favored 3G agents by 7% (95% confidence interval [CI]: 2%, 12%).Four trials (n ϭ 871 patients) compared treatment with 3G monotherapy versus 2G platinum-based regimens.The response RD was Ϫ6% (95% CI: Ϫ11%, 0%), and the 1-year survival rate RD was 3% (95% CI: Ϫ3%, 10%), suggesting that despite a slightly higher response rate for 2G platinum-based regimens relative to 3G monotherapy, there is equivalency in survival.Twelve trials (n ϭ 3995) compared 3G versus 2G platinumbased regimens.The RD for response was 12% (95% CI: 10%, 15%).A RD for 1-year was not calculated, because of heterogeneity among the trials.A subset analysis of 3G versus 2G platinum-based doublets revealed a 1-year survival-rate RD of 6% (95% CI: 2%, 10%), favoring 3G platinum-based regimens without evidence of heterogeneity.Conclusions: 3G agents have been a significant advance in the treatment of NSCLC.
DOI: 10.17615/c91v-5d19
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4298485120