Abstract
PurposeWe performed a systematic review and meta-analysis to investigate the efficacy of third-line treatment for advanced non-small-cell lung cancer (NSCLC).Materials and MethodsRelevant trials were identified by searching electronic databases and conference meetings. Prospective randomized controlled trials (RCTs) assessing third-line therapy in advanced NSCLC patients were included. Outcomes of interest included overall survival (OS) and progression-free survival (PFS).ResultsA total of 1,985 advanced NSCLC patients received third-line treatment from 11 RCTs were included for analysis. The use of single targeted agent as third-line therapy for advanced NSCLC did not significantly improved PFS (HR 0.75, 95% CI: 0.28–2.04, p = 0.58) and OS (HR 1.01, 95% CI: 0.86–1.17, p = 0.95) when compared to docetaxel alone. In addition, erlotinib-based doublet combination therapy did not significantly improved PFS (HR 0.94, 95% CI: 0.78–1.13, p = 0.49) and OS (HR 1.08, 95% CI: 0.78–1.51, p = 0.65) in comparison with erlotinib alone.ConclusionsThe findings of this study show that the efficacy of single novel targeted agent is comparable to that of docetaxel alone in terms of PFS and OS for heavily pretreated NSCLC patients. In addition, no survival benefits are obtained from erlotinib-based doublet therapy, thus single agent erlotinib could be recommended as third-line treatment for unselected advanced NSCLC patients.
Highlights
Despite a significant improvement in diagnostics and therapy during the past decade, lung cancer remains the leading cancer-related deaths around the world [1]
The use of single targeted agent as third-line therapy for advanced non-small-cell lung cancer (NSCLC) did not significantly improved progression-free survival (PFS) (HR 0.75, 95% CI: 0.28–2.04, p = 0.58) and overall survival (OS) (HR 1.01, 95% CI: 0.86–1.17, p = 0.95) when compared to docetaxel alone
No survival benefits are obtained from erlotinib-based doublet therapy, single agent erlotinib could be recommended as third-line treatment for unselected advanced NSCLC patients
Summary
Despite a significant improvement in diagnostics and therapy during the past decade, lung cancer remains the leading cancer-related deaths around the world [1]. Two previously published trials demonstrate that docetaxel is superior to best support care (BSC), vinorelbine, or ifosfamide, in terms of survival benefits and quality of life (QoL) for the treatment of advanced NSCLC patients previously treated with platinum-based chemotherapy [7, 8]. In another large non-superiority phase III trials, pemetrexed is compared with docetaxel in patients with good PS (0–2), and the result shows no significant www.oncotarget.com difference in overall survival between pemetrexed and docetaxel (8.3 months vs 7.9 months, HR, 0.99; P = 0.226), but with less toxicities of pemetrexed [9]. These is no prospective trials addressing the role of third-line treatment in advanced NSCLC, we conduct this meta-analysis of randomized controlled trials reporting survival data of those patients who have already received ≥ 2 prior regimens to clearly determine the role of third-line treatment in NSCLC
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