Paclitaxel plus platinum or gemcitabine plus platinum in first-line treatment of advanced non-small-cell lung cancer: results from 6 randomized controlled trials

Abstract

The aim was to compare the efficacy and toxicity of paclitaxel plus platinum (TP) with gemcitabine plus platinum (GP) in untreated advanced non-small-cell lung cancer by a meta-analysis. An extensive literature search was performed for relevant randomized controlled trials. Studies were evaluated for eligibility and quality, and then the data were extracted and analyzed using Review Manager 5.1 software. Publication bias was evaluated according to Begg's funnel plot and Egger's test using Stata/SE version 10.1 software. Six randomized controlled trials including 2,793 patients were ultimately identified. The meta-analysis demonstrated that the efficacy was comparable between TP and GP regimens according to the pooled relative risks (RRs) for overall response rate [0.99, 95% confidence interval (CI)=0.88-1.13, p=0.92], disease control rate (0.96, 95% CI=0.90-1.03, p=0.24) and 1-year survival (0.99, 95% CI=0.90-1.09, p=0.87), and the hazard ratios for overall survival (1.06; 95% CI=1.00-1.13, p=0.07) and time-to-progression of disease (1.05, 95% CI=0.97-1.14, p=0.20). Grade 3-4 nausea or vomiting, anemia and thrombocytopenia were less frequent in the TP group (RR=0.53, 95% CI=0.35-0.78, p=0.002; RR=0.37, 95% CI=0.30-0.45, p<0.00001; RR=0.20, 95% CI=0.14-0.27, p<0.00001; respectively). Grade 3-4 sensory neuropathy, fatigue and neutropenia were comparable between the two groups. Sensitivity analyses in studies of paclitaxel compared with gemcitabine combined with the same platinum strengthened the above conclusion. Our meta-analysis showed that paclitaxel plus platinum had similar efficacy and less toxicity compared with gemcitabine plus platinum in first-line treatment of advanced non-small-cell lung cancer.