Single agent versus combination chemotherapy in patients with advanced nonsmall cell lung carcinoma : A meta-analysis of response, toxicity, and survival

✍ Scribed by Rogerio C. Lilenbaum; Patricia Langenberg; Kay Dickersin

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 182 KB
• Volume: 82
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19980101)82:1<116::aid-cncr14>3.0.co;2-5

✦ Synopsis

Background:

This meta-analysis was conducted to compare the effects of single agent versus combination chemotherapy on response rate, toxicity, and survival of patients with advanced nonsmall cell lung carcinoma (nsclc).

Methods:

The authors reviewed randomized clinical trials published in the medical literature and the reference lists of relevant articles. objective response rate, survival at 6 and 12 months, and the incidence of treatment-related death were compared among all patients receiving single agent chemotherapy and those receiving combination chemotherapy. a subgroup analysis for all outcomes was conducted for 10 trials published between 1989 and 1996 that used a platinum analogue or vinorelbine as the single agent arm.

Results:

The authors identified 38 potentially eligible trials, 25 of which (with a total of 5156 patients) were included in the meta-analysis. overall, combination chemotherapy produced a nearly 2-fold increase in response rate compared with single agent chemotherapy (response rate [rr], 1.93; 95% confidence interval [ci], 1.54-2.42). however, combination chemotherapy also increased toxicity significantly, including a 3.6-fold increase in the risk of treatment-related death (rr, 3.5; 95% ci, 1.8-6.7). survival at 6 months (rr, 1.10; 95% ci, 1.02-1.19) and 12 months (rr, 1.22; 95% ci, 1.03-1.45) was modestly superior with combination chemotherapy when all trials are included. however, when a platinum analogue or vinorelbine are used as single agents, this difference was no longer statistically significant at 6 months (rr, 1.03; 95% ci, 0.92-1.15) or at 12 months (rr, 1.10; 95% ci, 0.94-1.43).

Conclusions:

Combination chemotherapy increased objective response and toxicity rates compared with single-agent chemotherapy. survival was prolonged only modestly with combination chemotherapy but not significantly so when more active single agents were used.