Abstract
Platinum regimens still play a key role in chemotherapy for incurable non-small cell lung cancer (NSCLC). Although guidelines list many platina regimens, the best regimens have not yet clarified. Electronic searches were carried out during November 26th-28th, 2016. We included individually randomized trials comparing two or more platinum regimes for incurable chemo-naive NSCLC published in English full papers. The platinum doublets should be either Cisplatin (CDDP), Carboplatin (CBDCA), or Nedaplatin (CDGP) plus one of the third-generation agents. The platinum triplet should be the doublet plus bevacizumab (BEV). The data were independently extracted and cross-checked by two investigators. We did not observed heterogeneity (whole network level Q = 28.9, df = 34, P = 0.717) among 59 pairwise comparisons from 45 studies with 16141 cases for the primary outcome, hazard ratio for overall survival (HRos). Using CBDCA + Paclitaxel (PTX) + BEV as a common comparator, CDGP + Docetaxel (DTX) (HRos = 0.98, 95%CI: 0.75–1.29, P = 0.884), CDDP + Tegafur gimeracil oteracil (S1) (HRos = 1.23, 95%CI: 0.96–1.57, P = 0.099), CBDCA + S1 (HRos = 1.23, 95%CI: 0.99–1.53, P = 0.062), and CDGP + Gemcitabine (GEM) (HRos = 1.24, 95%CI: 0.71–2.17, P = 0.45) did not have significantly poorer HRos. We suggest that these regimens as acceptable first-choice regimens.
Highlights
Non-small cell lung cancer (NSCLC), which is currently the most common malignant neoplasm in the world, is one of the leading causes of cancer death worldwide[1]
When a network diagram showed two or more independent loops, we evaluated only the loop that contained major platinum regimes such as CDDP + PEM and CBDCA + PTX + BEV2,3
We eventually evaluated 102 arms, of which 92 were platinum doublet and 10 were platinum triplet. Both CDDP + VNR and CBDCA + PTX were the most frequently used arms, and were evaluated in 15 studies, followed by CDDP + GEM evaluated in 14 studies
Summary
Non-small cell lung cancer (NSCLC), which is currently the most common malignant neoplasm in the world, is one of the leading causes of cancer death worldwide[1]. In more than a half of cases, the NSCLC is detected after the disease has already progressed to an incurable stage For such patients, chemotherapy is usually the first-choice treatment option because accumulated evidence has revealed that current standard chemotherapy treatments have substantial benefits for advanced, locally advanced, and recurrent NSCLC. Network meta-analysis is a recently developed technique to integrate available data This analysis has the advantages of allowing collective comparison among multiple treatment arms and the potential precision gains from combining direct and indirect evidence[7,8,9]. The goal of the current network meta-analysis is to identify and rank the best standard regimens by comparing the effectiveness and safety of a variety of the platinum regimens as first-line chemotherapies for advanced, locally advanced, and recurrent NSCLC
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