Article Text

PDF
A systematic review of the clinical effectiveness of first-line chemotherapy for adult patients with locally advanced or metastatic non-small cell lung cancer
  1. Gerlinde Pilkington1,
  2. Angela Boland1,
  3. Tamara Brown2,
  4. James Oyee3,
  5. Adrian Bagust1,
  6. Rumona Dickson1
  1. 1Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK
  2. 2Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  3. 3Covance Clinical Development Services, Maidenhead, UK
  1. Correspondence to Dr Angela Boland, Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Room 2.08 Whelan Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, UK, angiela{at}liverpool.ac.uk

Abstract

Our aim was to evaluate the clinical effectiveness of chemotherapy treatments currently licensed in Europe and recommended by the National Institute for Health and Care Excellence (NICE) for the first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). A systematic search of MEDLINE, EMBASE and the Cochrane Library for randomised controlled trials (RCTs) published from 2001 to 2010 was carried out. Relative treatment effects for overall survival (OS) and progression-free survival (PFS) were estimated using standard meta-analysis and mixed treatment comparison methodology. A total of 23 RCTs were included: 18 trials compared platinum-based chemotherapy, two compared pemetrexed and three compared gefitinib. There are no statistically significant differences in OS between any of the four third-generation chemotherapy regimens. There is statistically significant evidence that pemetrexed+platinum increases OS compared with gemcitabine+platinum. There are no statistically significant differences in OS between gefitinib and docetaxel+platinum or between gefitinib and paclitaxel+platinum. There is a statistically significant improvement in PFS with gefitinib compared with docetaxel+platinum and gefitinib compared with paclitaxel+platinum. Due to reduced generic pricing, third-generation chemotherapy regimens (except vinorelbine) are still competitive options for most patients. This research provides a comprehensive evidence base, which clinicians and decision-makers can use when deciding on the optimal first-line chemotherapy treatment regimen for patients diagnosed with locally advanced or metastatic NSCLC.

  • Lung Cancer
  • Lung Cancer Chemotherapy
  • Non-Small Cell Lung Cancer

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.