Meta-Analysis Shows No Overall Survival Benefit of Six vs Fewer Planned Cycles of First-Line Platinum-Based Chemotherapy in Advanced NSCLC
In a systematic review and meta-analysis of individual patient data reported in The Lancet Oncology, Rossi et al found no overall survival benefit with six vs fewer than six planned cycles of first-line platinum-based treatment in patients with advanced non–small cell lung cancer (NSCLC).
A total of five eligible randomized trials comparing six vs fewer than six planned cycles in this setting were identified. Individual patient data could be collected from four of these trials (conducted in UK, Norway/Sweden, South Korea, and Portugal), which included 1,139 patients receiving six cycles (n = 568) and 571 patients receiving either three cycles (two studies) or four cycles (two studies). Patients received cisplatin in two trials and carboplatin in two trials.
No Improvement in Overall Survival
Median overall survival was 9.54 months (95% confidence interval [CI] = 8.98–10.69 months) in patients assigned to six cycles vs 8.68 months (95% CI = 8.03–9.54 months) in those assigned to fewer (hazard ratio [HR] = 0.94, P = .33). There was evidence of potential heterogeneity among trials (P = .076, I2 = 56%). There was no significant interaction of treatment with histology, sex, performance status, or age.
Median progression-free survival was 6.09 months (95% CI = 5.82–6.87 months) vs 5.33 months (95% CI = 4.90–5.62 months; HR = 0.79, P = .0007). Objective response was reported in 41.3% vs 36.5% of patients (P = .16).
Data on severe toxicity indicated that only grade ≥ 3 anemia was more common with six planned cycles (7.8% vs 2.9%).
The investigators concluded: “Six cycles of first-line platinum-based chemotherapy did not improve overall survival compared with three or four courses in patients with advanced non-small cell lung cancer. Our findings suggest that fewer than six planned cycles of chemotherapy is a valid treatment option for these patients.”
Antonio Rossi, MD, of S.G. Moscati Hospital, Avellino, Italy, is the corresponding author for The Lancet Oncology article.
The authors declared no potential conflicts of interest.
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