A literature-based meta-analysis about the comparison between platinum-based doublet and single agent chemotherapy in PS 2 NSCLC patients
|Date||28 March 2014|
|Session||Lunch and poster display session|
|Topics|| Anti-Cancer Agents & Biologic Therapy
Non-Small-Cell Lung Cancer, Metastatic
Cancer in Special Situations
|Citation||Journal of Thoracic Oncology (2014) 9 (Supplement 9): S7-S52. 10.1097/JTO.0000000000000131|
C.D. Rolfo1, F. Passiglia1, G. Bronte2, S. Rizzo2, I. Gil Bazo3, E. fiorentino4, J.P. van Meerbeeck5, A. Russo2
Background: Platinum-based doublet chemotherapy is still the standard 1st-line treatment for most EGFR wild-type NSCLC patients with performance status (PS) 0-1. However the treatment of PS2 patients is still controversial. Single-agent treatment with third-generation agents is recommended as the best option. Recently new prospective, randomized- phase III trials showed very interesting updates regarding the treatment of PS2 population. This meta-analysis aims to review all randomized trials comparing platinum-based doublets and single-agents in NSCLC PS2 patients.
Data from all published randomized trials, that compared efficacy and safety of platinum-based doublets to single agents in untreated NSCLC patients either wholly or partially dedicated to PS2, were collected by searching in PubMed and Cochrane Library. Pooled ORs were calculated for the 1-Year Survival-Rate (1-Y-SR), Overall Response Rate (ORR), and grade 3-4 (G3-4) hematologic toxicities.
Five eligible trials (620 NSCLC PS2 patients) were selected among 1367 studies. Pooled analysis showed a significant improvement in ORR (OR: 3,243; 95% CI: 1,883-5,583) and 1-Y-SR (OR: 1,906; 95% CI: 1,281-2,836) in favor of platinum doublet chemotherapy. Hematologic toxicity data were obtained from 4 out of these 5 trials. G3-4 anemia (OR: 2,743; 95% CI: 1,359-5,536), neutropenia (OR: 7,956; 95% CI: 3,999-15,828) and thrombocytopenia (OR: 12,882; 95% CI: 4,901-33,857) were observed more frequently in patients receiving platinum.
This meta-analysis suggests that platinum-based combination regimens are superior to single-agent chemotherapy both in terms of ORR and survival-rate with increase of severe hematological toxicities. Carboplatin-based combination appears a feasible treatment option in first-line therapy of wild-type NSCLC PS2 patients. However we need to better understand which factors induce a worse PS, i.e. comorbidities or tumor burden, to select a favorable subgroup of patients who could better tolerate platinum-based doublet chemotherapy.
All authors have declared no conflicts of interest.