Abstract 1188P
Background
Determining the most appropriate chemotherapy regimen to accompany thoracic radiotherapy is of the utmost importance in keeping up to the fast-changing stage III non-small-cell lung cancer (NSCLC) treatment. We conducted the individual-patient-data (IPD) meta-analysis of comparing “S-1 plus cisplatin” versus “other third-generation anti-cancer agent plus cisplatin” to determine whether S-1/CDDP was the ideal choice for treatment accompanied by RT.
Methods
A thorough search was performed using multiple electronic databases. We integrated the IPD of each trial and analyzed the resulting meta-database. The primary endpoint was overall survival (OS) and the secondary endpoints included progression-free survival (PFS), objective response rate (ORR), toxicities, and treatment delivery. Statistical analyses were stratified by trials.
Results
3 randomized trials were identified; CDDP/S-1 was compared to CDDP/VNR, CDDP/PEM, and CDDP/DTX in the WJOG5008L, SPECTRA, and TORG1018, respectively. Of 316 patients enrolled, 159 received S-1/cisplatin (SP), and 159 were assigned to non-SP chemotherapy. The median OS for the SP was 48.2 months(mo), and that of the non-SP was 42.4 mo. The combined HR for OS by the fixed-model was 0.895(95%CI, 0.638-1.256), with no evidence of heterogeneity(test for heterogeneity, p=0.87; I2=0). The median PFS for the SP and non-SP was 12.8 mo and 14.0 mo. The HR for PFS was 1.022 (0.776-1.347), with an evidence of moderate heterogeneity(test for heterogeneity, p=0.16; I2=0.46).The ORRs were 69.7% (62.1%-76.7%) and 70.9% (63.7%-78.1%) in the SP and the non-SP. The incidents of grade3-4 leukopenia and neutropenia in SP (37.1% and 33.3%) were significantly lower than that in the non-SP (65.6% and 61.8%) (p<0.01). Of those who received more than 2 courses of chemotherapy, a dose reduction was needed in 26 (17.9%) and 42 (27.4%) in the SP and non-SP(p=0.049). The proportion of patients receiving subsequent chemotherapy was 95.3% in the SP and 81.8% in non-SP (p=0.0098).
Conclusions
No marked difference was confirmed in the OS, PFS, or ORR between SP and non-SP. SP had a significantly lower myelosuppression and better treatment compliance as concurrent chemoradiation regimen in locally advanced NSCLC.
Clinical trial identification
Editorial acknowledgement
Dr. K. Takeda from West Japan Oncology Group for providing WJOG5008L data.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
Y. Taniguchi: Financial Interests, Institutional, Research Grant: Bristol Myers Squibb; Financial Interests, Institutional, Research Grant: Chugai; Financial Interests, Institutional, Research Grant: Taiho Pharmaceutical; Financial Interests, Institutional, Research Grant: AstraZeneca. H. Okamoto: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal and Institutional, Invited Speaker: Chugai; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal and Institutional, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Kyorin; Financial Interests, Institutional, Invited Speaker: Taiho; Financial Interests, Institutional, Invited Speaker: Astellas; Financial Interests, Institutional, Invited Speaker: Eli Lilly; Financial Interests, Institutional, Invited Speaker: Merck BioPharma. T. Shimokawa: Financial Interests, Institutional, Research Grant: Bristol Myers Squibb; Financial Interests, Institutional, Research Grant: Chugai; Financial Interests, Institutional, Research Grant: Pharma; Financial Interests, Institutional, Research Grant: Taiho Pharmaceutical; Financial Interests, Institutional, Research Grant: AstraZeneca. T. Sasaki: Financial Interests, Personal, Invited Speaker: AstraZeneca. T. Seto: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Bristol Myers Squibb; Financial Interests, Personal and Institutional, Invited Speaker: Chugai; Financial Interests, Personal, Invited Speaker: Covidien Japan; Financial Interests, Personal and Institutional, Invited Speaker: Daiichi Sankyo; Financial Interests, Personal and Institutional, Invited Speaker: Eli Lilly Japan; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal, Invited Speaker: Nippon Boehringer Ingelheim; Financial Interests, Personal and Institutional, Invited Speaker: Novartis Pharma; Financial Interests, Personal, Invited Speaker: Ono Pharmaceutical; Financial Interests, Personal and Institutional, Invited Speaker: Pfizer Japan; Financial Interests, Personal, Invited Speaker: Taiho Pharmaceutical; Financial Interests, Personal, Invited Speaker: Thermo Fisher Scientific; Financial Interests, Institutional, Research Grant: AbbVie; Financial Interests, Institutional, Research Grant: Kissei Pharmaceutical; Financial Interests, Institutional, Research Grant: Merck Biopharma; Financial Interests, Institutional, Research Grant: Takeda Pharmaceutical; Financial Interests, Personal, Full or part-time Employment: Precision Medicine Asia. S. Niho: Financial Interests, Personal and Institutional, Invited Speaker: AstraZeneca; Financial Interests, Personal and Institutional, Invited Speaker: Taiho; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal and Institutional, Invited Speaker: Pfizer; Financial Interests, Personal and Institutional, Invited Speaker: MSD; Financial Interests, Personal and Institutional, Invited Speaker: Chugai; Financial Interests, Personal and Institutional, Invited Speaker: Ono; Financial Interests, Personal, Invited Speaker: Kyorin; Financial Interests, Personal and Institutional, Invited Speaker: Eli Lilly; Financial Interests, Personal, Invited Speaker: Janssen; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Advisory Board: Pfizer; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Institutional, Research Grant: Merck Serono; Financial Interests, Institutional, Research Grant: Sanofi; Financial Interests, Institutional, Research Grant: Shionogi; Financial Interests, Institutional, Research Grant: Takeda; Financial Interests, Institutional, Research Grant: Teijin; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. Y. Ohe: Financial Interests, Personal and Institutional, Invited Speaker: AstraZeneca; Financial Interests, Personal and Institutional, Invited Speaker: Chugai; Financial Interests, Personal and Institutional, Invited Speaker: Eli Lilly; Financial Interests, Personal and Institutional, Invited Speaker: Ono; Financial Interests, Personal and Institutional, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal, Invited Speaker: Bayer; Financial Interests, Personal and Institutional, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: MSD; Financial Interests, Personal and Institutional, Invited Speaker: Taiho; Financial Interests, Personal, Invited Speaker: Nippon Kayaku; Financial Interests, Personal, Invited Speaker: Kyowa Hakko Kirin; Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: Chugai; Financial Interests, Personal, Advisory Board: Ono; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal and Institutional, Advisory Board: Kyorin; Financial Interests, Personal, Advisory Board: Celltrion; Financial Interests, Personal, Advisory Board: Amgen; Financial Interests, Personal, Advisory Board: Nippon Kayaku; Financial Interests, Institutional, Research Grant: Dainippon-Sumitomo; Financial Interests, Institutional, Research Grant: Novartis; Financial Interests, Institutional, Research Grant: Ignyta; Financial Interests, Institutional, Research Grant: Takeda; Financial Interests, Institutional, Research Grant: Kissei; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: Janssen; Financial Interests, Institutional, Research Grant: Loxo. T. Yamanaka: Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: Otsuka; Financial Interests, Personal and Institutional, Invited Speaker: Ono; Financial Interests, Personal, Invited Speaker: Kyowa Kirin; Financial Interests, Personal and Institutional, Invited Speaker: Taiho; Financial Interests, Personal and Institutional, Invited Speaker: Takeda; Financial Interests, Personal and Institutional, Invited Speaker: Chugai; Financial Interests, Personal and Institutional, Invited Speaker: Boehringer Ingelheim; Financial Interests, Personal and Institutional, Invited Speaker: Bayer; Financial Interests, Personal, Invited Speaker: Gilead Sciences; Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Merk Serono; Financial Interests, Institutional, Research Grant: Astellas; Financial Interests, Institutional, Research Grant: Daiichi Sankyo; Financial Interests, Institutional, Research Grant: EPS. All other authors have declared no conflicts of interest.