Meta-analysis Slightly Favors Platinum-based First-line Treatment in Patients with Advanced NSCLC

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Overall, the data showed a slightly improved survival in patients who received platinum-based regimens over patients treated with non–platinum-containing regimens.

—Thierry Berghmans, MD, and colleagues

Several meta-analyses conducted in the past have suggested that survival of patients with advanced non–small cell lung cancer (NSCLC) is improved if first-line chemotherapy includes platinum derivatives. Results from a new meta-analysis of randomized clinical trials show that platinum-based regimens slightly improve survival compared with nonplatinum strategies, and this effect is restricted to cisplatin combinations. The findings were presented by Thierry Berghmans, MD, of the Department of Intensive Care and Emergencies and the Clinic of Thoracic Oncology, Institute Jules Bordet in Brussels, Belgium, at the European Multidisciplinary Conference in Thoracic Oncology, held recently in Lugano, Switzerland.1

Study Design

The Belgian researchers evaluated all studies published in French and English that compared first-line platinum to nonplatinum regimens in patients with advanced/metastatic NSCLC. For each of 25 studies published between 2001 and 2012 that were eligible for the systematic review, the authors extracted an estimate of the hazard ratio associated with platinum or nonplatinum treatment and combined the individual hazard ratios into an aggregate number for each treatment modality. Either a fixed or a random-effects model (if heterogeneity was statistically significant) was used for this purpose, using data from 23 trials that allowed a quantitative aggregation for meta-analysis.

The number of patients per trial ranged from 80 to 557 and totalled 6,930 for all trials. Cisplatin was the comparator in 15 trials involving 4,644 participants, and carboplatin was compared in 8 trials comprising 2,286 patients; the hazard ratio was 1.075 for cisplatin and 1.099 for carboplatin. Values for the heterogeneity test were P = .001 with cisplatin and P = .53 with carboplatin. In all 23 studies, the hazard ratio was 1.084 (P = .02).

Major Findings

Only four studies demonstrated a statistically significant survival difference between treatments, with three studies favoring platinum and one favoring nonplatinum therapy. Overall, the data showed a slightly improved survival in patients who received platinum-based regimens over patients treated with non–platinum-containing regimens. However, this effect was seen only with cisplatin combinations.

Ongoing analyses of patient subgroups according to quality trial assessment (based on Cochrane guidelines) and to the type of nonplatinum comparator are underway to better define the role of nonplatinum regimens for first-line treatment of patients with advanced NSCLC. ■

Disclosure: The study authors reported no potential conflicts of interest.


1. Berghmans T, Paesmans M, Meert AP, et al: Are first-line platinum-based regimens improving survival in comparison with non-platinum chemotherapy in advanced non-small cell lung cancer? A meta-analysis of randomised trials. European Multidisciplinary Conference in Thoracic Oncology. Abstract 670. Presented May 10, 2013.

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