Maintenance or consolidation therapy in small-cell lung cancer: A systematic review and meta-analysis

Objective: To assess the role of maintenance or consolidation therapy in the treatment of small-cell lung cancer (SCLC), a meta-analysis of all published randomized clinical trials (RCTs) was performed in order to provide an overall meta-analysis and indirectly compare the effect of chemotherapy, interferons, and other biologic agents. Methods: Electronic databases were searched for publication reporting of RCTs comparing maintenance or consolidation therapy versus placebo or follow-up alone until December 2008. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), with their relative 95% confidence intervals (CI), were derived. In the calculation of HRs, the " no maintenance" arm served as a reference. The a priori value of p2 test for heterogeneity: 8.07 [3 df]; p=0.04), but not for PFS. A statistically significant reduction of mortality was detected in those studies assessing the efficacy of chemotherapy (HR 0.89, 95% CI 0.81-0.98; p=0.02) and of interferon-alpha (HR 0.78, 95% CI 0.64-0.96; p=0.02). Conclusions: The maintenance or the consolidation approach failed to improve the outcomes of SCLC. A survival advantage is suggested for maintenance chemotherapy and interferon-alpha, but its clinical impact needs to be confirmed by further studies.