Platinum rechallenge in patients with advanced NSCLC: A pooled analysis

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• 作者：Fausto Petrelli ; Andrea Coinu ; Mary Cabiddu ; Mara Ghilardi ; Mara Ardine ; S ; ro Barni
• 关键词：NSCLC ; Metastatic ; Second line ; Platinum-based doublets ; Rechallenge
• 刊名：Lung Cancer
• 出版年：2013
• 出版时间：September, 2013
• 年：2013
• 卷：81
• 期：3
• 页码：337-342
• 全文大小：716 K

文摘

Introduction

The sole agents pemetrexed (PEM), docetaxel and anti-EGFR agents are approved second-line therapies for non-small cell lung cancer (NSCLC) after failure with cisplatin-based doublets. The potential usefulness of platinum-based doublets as rechallenge for second-line chemotherapy has not yet been established.

Methods

Studies that enrolled NSCLC platinum pre-treated patients were identified using electronic databases (MEDLINE and EMBASE). Pemetrexed and taxanes (TAXs)-based platinum combinations were considered. A systematic review was conducted using Comprehensive Meta-Analysis (version 2.2.064) software to calculate the event rate of response and 95 % confidence interval. Median weighted progression-free survival (PFS) and overall survival (OS) time for PEM and TAXs-based doublets were compared by two-sided Student's t test. We tested for significant heterogeneity by Cochran's chi-square test and I² index.

Results

Eleven studies published between 1999 and 2012 were included in this analysis with a total of 607 patients enrolled; 468 were treated with PEM-doublets and 139 with TAXs-doublets. The overall response rate was 27.5 % with a higher response rate of 37.8 % (range, 29.7-46.7 % ) for TAXs-based treatment vs. 22 % (range, 13.4-34.1 % ) for PEM-based combinations; (p < 0.0001). Median PFS and OS were 3.9 and 8.7 months with weighted PFS of 3.9 vs. 5.3 months (p < 0.0001) and similar OS for PEM vs. TAXs-based doublets.

Conclusions

With the limitations of small and not randomised trials included, this pooled analysis shows that NSCLC patients who relapsed after a first-line platinum-based chemotherapy obtain a tumour response of 27 % from a platinum rechallenge containing PEM or TAXs. Response rate and median PFS appear better with TAXs-than with PEM-doublets.