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Intervention Review

Chemotherapy versus best supportive care for extensive small cell lung cancer

  1. Marta Pelayo Alvarez1,*,
  2. Óscar Gallego Rubio2,
  3. Xavier Bonfill Cosp3,
  4. Yolanda Agra Varela4

Editorial Group: Cochrane Lung Cancer Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 2 APR 2009

DOI: 10.1002/14651858.CD001990.pub2


How to Cite

Pelayo Alvarez M, Gallego Rubio Ó, Bonfill Cosp X, Agra Varela Y. Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001990. DOI: 10.1002/14651858.CD001990.pub2.

Author Information

  1. 1

    Conselleria Valenciana, Atención Primaria área 11, Valencia, Spain

  2. 2

    Hospital de la Santa Creu i Sant Pau, Servicio de Oncología, Barcelona, Spain

  3. 3

    Universitat Autònoma de Barcelona, Iberoamerican Cochrane Centre. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain

  4. 4

    Ministerio de Sanidad y Política Social, Agencia de Calidad del SNS, Madrid, Spain

*Marta Pelayo Alvarez, Atención Primaria área 11, Conselleria Valenciana, Valencia, Spain. MPelayo@ribera10.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 OCT 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Combination chemotherapy has been the mainstay of treatment for extensive stage small celI lung cancer (SCLC) over the last 30 years even though it only gives a short prolongation in median survival time. The main goal for these patients should be palliation with the aim of improving their quality of life.

Objectives

To evaluate the effectiveness of chemotherapy in extensive SCLC compared with best supportive care (BSC) or placebo treatment.

Search methods

MEDLINE (1966 to July 2008), EMBASE (1974 to week 31, 2008), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2008). Experts in the field were contacted.

Selection criteria

Randomised controlled trials in which any chemotherapy treatment was compared with  placebo or BSC in patients with extensive SCLC, as first or second therapy at relapse.

Data collection and analysis

Two authors independently extracted data and assessed study quality. We resolved disagreements by discussion. Additional information was obtained from one study author.

Main results

Two studies were included for first-line chemotherapy. A total of 65 patients were randomised to receive either placebo or ifosfamide. Ifosfamide gave an extra mean survival of 78.5 days compared with placebo. Partial tumour response was greater with the active treatment. Toxicity was only seen in the chemotherapy group.

Two studies were included for second-line chemotherapy at relapse. A total of 531 patients were randomised to receive either methotrexate-doxorubicin or symptomatic treatment, or to receive oral topotecan versus BSC. The methotrexate-doxorubicin treatment gave a median survival of 63 days longer than in the symptomatic treatment group, and 21 days longer for patients allocated to receive four or eight cycles of first-line chemotherapy, respectively.

Treatment with topotecan gave a median survival of 84 days longer than in the BSC group (log-rank P = 0.01). The adjusted hazard ratio for overall survival was 0.61 (95% CI, 0.43 to 0.87). Partial or complete response in the methotrexate-doxorubicin group was 22.3%. Five patients (7%, 95% CI, 2.33 to 15.67) showed a partial response with topotecan. Toxicity was worst in the chemotherapy group. Quality of life was better in the topotecan group.

Authors' conclusions

Chemotherapeutic treatment prolongs survival in comparison with placebo in patients with advanced SCLC. Nevertheless, the impact of first-line chemotherapy on quality of life and in patients with poor prognosis is unknown. Well-designed, controlled trials are needed to further evaluate the risks and benefits of different chemotherapeutic schedules in patients with advanced SCLC.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Chemotherapy (anticancer drugs) prolongs survival in patients with advanced small cell lung cancer

SmalI cell lung cancer accounts for nearly a quarter of all new cases of lung cancer. This cancer is often diagnosed after it has spread to the brain, liver, bone or bone marrow and most patients die in the first year after diagnosis. This review found that chemotherapy (anticancer drugs) prolonged survival in patients with advanced small cell lung cancer, both at diagnosis and at relapse in comparison with placebo and best supportive care, although the effect of this treatment on quality of life is unknown when used as first therapy. Further research is needed in patients with poor prognosis.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

化學治療與最佳的支持性照護在蔓延期小細胞肺癌的比較

在過去25年中,複方化學治療一直是治療蔓延期小細胞肺癌的主軸,可是也只能短暫的延長存活時間。如果存活預後有限,適當的緩解病症以改善生活品質應該是治療的主要目標

目標

評估化學治療或者是最佳的支持性照護或安慰劑在蔓延期小細胞肺癌病人的效力。

搜尋策略

我們搜尋了Medline (1966年到2003年1月), Embase (1974年到2003年1月), Cancerlit (1993年到2003年1月) and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2002)。同時連絡這個領域的專家以發現是否有沒在此電子資料庫內的研究。

選擇標準

在蔓延期小細胞肺癌病人比較化學治療或者是安慰劑或最佳的支持性照護的隨機對照試驗.。

資料收集與分析

由2位作者來選擇資料並做品質評估。若有不同的意見,則由第三位作者來解決。摘錄的研究中的額外資訊則是從原作者處取得

主要結論

只有2個研究(第一篇是在1977年發表,第二篇是在1982年發表)符合本篇回顧文章的條件,總共有65個蔓延期的病人(33個病人是屬於第一個研究,32個病人是屬於第二個研究)被隨機分配接受安慰劑或ifosfamide的治療。在第二個研究的第三個分組是比較ifosfamide加CCNU。Ifosfamide組的病人比安慰劑組的病人多了78.5平均存活日。積極的治療有較好的部份腫瘤反應,毒性只出現在化學治療的組別。因為在這2個研究中只有提到平均存活時間所以無法作綜合分析。

作者結論

與安慰劑比較,化學治療是延長了蔓延期小細胞肺癌病人的存活期,但是對於生活品質的幫助以及對預後不良病患的影響則仍是未知。所以需要良好設計的對照試驗來進一步評估不同的化學治療處方在蔓延期小細胞肺癌病人的危險性和效力。

翻譯人

本摘要由臺北榮民總醫院馮嘉毅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

化學治療(抗癌藥物)的確可延長蔓延期小細胞肺癌病人的存活期。小細胞肺癌佔了將近四分之一的新診斷肺癌人數,通常病患是在發生了腦部、肝臟、骨頭或骨髓轉移才診斷,而且大多數的病人在診斷後的一年內死亡。這篇回顧發現,與安慰劑或最佳的支持性照護比較,化學治療(抗癌藥物)可延長蔓延期小細胞肺癌病人的存活期,但是對於生活品質的幫助仍是未知。我們需要更多針對此類預後不佳病人的研究。