Chemotherapy plus best supportive care versus best supportive care in patients with non-small cell lung cancer: a meta-analysis of randomized controlled trials.

Chenxi Zhong,Wei Zhang,Feng Yao,Liyan Jiang,Hongcheng Liu,Sevtap Savas

doi:10.1371/journal.pone.0058466

Abstract

BackgroundThe use of chemotherapy has been proposed to increase the effectiveness of best supportive care (BSC) in patients with non-small cell lung cancer (NSCLC). Previous trials reported inconsistent findings regarding the efficacy and safety of chemotherapy on overall survival (OS) and treatment-related mortality. We performed a systematic review and meta-analysis to evaluate the effects of chemotherapy plus BSC versus BSC alone on survival of patients with NSCLC.Methodology and Principal FindingsWe systematically searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literature. All eligible studies included patients with NSCLC who had received chemotherapy and BSC or BSC alone. All eligible studies measured at least 1 of the following outcomes: OS or treatment-related mortality. Overall, patients that received chemotherapy plus BSC had significant longer OS than those that received BSC alone (HR, 0.76; 95%CI, 0.69–0.84; P<0.001). Additionally, chemotherapy plus BSC as compared to BSC alone resulted in a 28% RR reduction (95%CI: 12–40; P = 0.001) in 6-month mortality, 11% RR reduction (95%CI: 8–15; P<0.001) in 12-month mortality, and 5% RR reduction (95%CI: 1–8; P = 0.02) in 2-year mortality. Toxicity was greater in patients that received chemotherapy plus BSC.Conclusion/SignificanceChemotherapy plus BSC increased the OS and reduced the 6-month, 12-month, and 2-year mortality of NSCLC patients.

Highlights

Lung cancer is the leading cause of cancer death worldwide for both men and women
Nine out of the included trials [19,22,26,27,28,29,30,31,32] were evaluating platinum-based chemotherapy plus best supportive care (BSC) compared with BSC alone, 2 [17,18] were assessing gemcitabine or vinorelbine therapy plus BSC compared with BSC alone, 3 [20,21,25] were evaluating taxel therapy compared with BSC alone, and the remaining 2 [23,24] assessed the effects of pemetrexed therapy compared with BSC alone
We noted that treatment with chemotherapy plus BSC were associated with significant increase in the risks of neutropenia, leukopenia, anemia, infection, nausea/vomiting, alopecia, and ankle swelling (Table 2)

Summary

Introduction

Lung cancer is the leading cause of cancer death worldwide for both men and women. NSCLC accounts for approximately 80– 85% of all lung cancer cases and is the most common cause of cancer death in industrialized countries [1,2]. Surgery is generally regarded as the best treatment option; only approximately 30% of lung cancers are suitable for potentially curative resection. The remaining 50% of patients with metastatic disease received BSC, and it has been suggested that addition of chemotherapy to BSC may offer further benefits [3]. The use of chemotherapy has been proposed to increase the effectiveness of best supportive care (BSC) in patients with non-small cell lung cancer (NSCLC).

Methods

Results

Conclusion