Is consolidation chemotherapy after concurrent chemoradiotherapy beneficial for locally advanced non-small cell lung cancer? A pooled analysis of the literature.

Abstract

7000 Background: There is a growing interest on the efficacy of maintenance chemotherapy to metastatic non-small cell lung cancer (NSCLC) and adjuvant chemotherapy to early stage NSCLC. However, the role of consolidation chemotherapy (CCT) after concurrent chemo-radiotherapy in locally advanced NSCLC is undetermined. Methods: We systematically searched PubMed for phase II/III trials examining survival of locally-advanced NSCLC treated with concurrent chemo-radiotherapy between January 1, 1995 and October 31, 2011. Median overall survival (mOS) and corresponding 95% confidence interval (CI) were collected from each study and pooled. We extracted log-transformated hazards and its standard errors under the assumption that survival follows an exponential distribution, and computed a pooled mOS and its 95% CI using random-effect model. Collected trial arms were divided into two groups by the presence of CCT: Arm with CCT (CCT+) and without CCT (CCT-). Results: Forty-five studies were identified including 9 phase III studies and 36 phase II studies with 51 arms (CCT+: 29, CCT-: 22). Clinical data were comparable in clinical stage, performance status, cancer histology, gender, and median age between the two groups. I2 values for assessing heterogeneity were 15.3, 9.1 and 24.2% in overall, CCT+ and CCT- studies, respectively. There was no statistical difference in pooled mOS between CCT+ (18.5 month, 95%CI: 16.7-20.5) vs CCT- (18.1 month, 95%CI: 16.5-20.2). In regard to the ≥ grade 3 toxicities in pneumonitis, esophagitis, and neutropenia, there was no difference between the two groups throughout the whole treatment courses. In random effect models, predicted hazard ratio of CCT+ to CCT- was 0.98 (95%CI: 0.8-1.13, p=0.7574). These models estimated that addition of CCT could not yield more than 3 months of survival prolongation for patients with locally advanced NCSLC. Conclusions: The pooled analysis on publication basis failed to provide evidence that consolidation chemotherapy yields significant survival benefit for locally advanced NSCLC.