Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second-line treatment of advanced non-small-cell lung cancer

Cesare Gridelli, Massimo Di Maio, Paolo Chiodini, Vassilis Georgoulias, Dora Hatzidaki, Koji Takeda, Floris M. Wachters, Vittorio Gebbia, Egbert F. Smit, Alessandro Morabito, Ciro Gallo, Francesco Perrone

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Abstract

Purpose Doublet chemotherapy is more effective than single-agent as first-line treatment of advanced non-small-cell lung cancer (NSCLC). As second-line treatment, several randomized trials have been performed comparing single-agent with doublet chemotherapy, but each trial had an insufficient power to detect potentially relevant differences in survival. Methods We performed meta-analysis of individual patient data from randomized trials, both published and unpublished, comparing single-agent with doublet chemotherapy as second-line treatment of advanced NSCLC. Primary end point was overall survival (OS). All statistical analyses were stratified by trial. Results Eight eligible trials were identified. Data of two trials were not available, and data of six trials (847 patients) were collected. Median age was 61 years. Performance status was 0 or 1 in 90%; 80% of patients had received previous platin-based chemotherapy. OS was not significantly different between arms (P =.32). Median OS was 37.3 and 34.7 weeks in the doublet and single-agent arms, respectively. Hazard ratio (HR) was 0.92 (95% CI, 0.79 to 1.08). Response rate was 15.1% with doublet and 7.3% with single-agent (P =.0004). Median progression-free survival was 14 weeks for doublet and 11.7 weeks for single agent (P =.0009; HR, 0.79; 95% CI, 0.68 to 0.91). There was no significant heterogeneity among trials for the three efficacy outcomes. Patients treated with doublet chemotherapy had significantly more grade 3 to 4 hematologic (41% v25%; P

Original languageEnglish
Pages (from-to)1836-1843
Number of pages8
JournalJournal of Clinical Oncology
Volume27
Issue number11
DOIs
Publication statusPublished - Apr 10 2009

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ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Gridelli, C., Maio, M. D., Chiodini, P., Georgoulias, V., Hatzidaki, D., Takeda, K., Wachters, F. M., Gebbia, V., Smit, E. F., Morabito, A., Gallo, C., & Perrone, F. (2009). Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second-line treatment of advanced non-small-cell lung cancer. Journal of Clinical Oncology, 27(11), 1836-1843. https://doi.org/10.1200/JCO.2008.17.5844