Platinum versus non-platinum chemotherapy regimens for small cell lung cancer
Editorial Group: Cochrane Lung Cancer Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 5 AUG 2008
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Amarasena IU, Walters JAE, Wood-Baker R, Fong K. Platinum versus non-platinum chemotherapy regimens for small cell lung cancer. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006849. DOI: 10.1002/14651858.CD006849.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
Small cell lung cancer (SCLC) is a very fast growing form of cancer and is characterised by early metastasis. As a result, chemotherapy is the mainstay of treatment. A number of different platinum-based chemotherapy regimens and non-platinum-based chemotherapy regimens have been used for the treatment of SCLC, with varying results. This review was conducted to analyse the data from these trials in order to compare their effectiveness.
To determine the effectiveness of platinum chemotherapy regimens compared with non-platinum chemotherapy regimens in the treatment of SCLC with respect to survival, tumour response, toxicity and quality of life.
We searched the biomedical literature databases CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE and CINAHL from 1966 to April 2007. In addition, we handsearched reference lists from relevant resources.
All randomised controlled trials involving patients with pathologically confirmed (cytological or histological) SCLC and the use of a platinum-based chemotherapy regimen in at least one treatment arm and a non-platinum-based chemotherapy regimen in a separate arm.
Data collection and analysis
Two authors independently assessed search results. We assessed included studies for methodological quality and recorded the following outcome data: survival, tumour response, toxicity and quality of life. We combined the results of the survival, tumour response and toxicity data in a meta-analysis.
A total of 29 trials involving 5530 patients were included in this systematic review. There was no statistically significant difference between treatment groups in terms of survival at 6 months, 12 months and 24 months. There was also no statistically significant difference in terms of overall tumour response. However, platinum-based treatment regimens did have a significantly higher rate of complete response. Platinum-based chemotherapy regimens had significantly higher rates of nausea and vomiting, anaemia and thrombocytopenia toxicity. Three trials presented quality of life data but the data presented were not complete and therefore could not be combined in a meta-analysis.
Platinum-based chemotherapy regimens did not offer a statistically significant benefit in survival or overall tumour response compared with non-platinum-based regimens. However, platinum-based chemotherapy regimens did increase complete response rates, at the cost of higher adverse events including nausea and vomiting, anaemia and thrombocytopenia toxicity. These data suggest non-platinum chemotherapy regimens have a more advantageous risk-benefit profile. This systematic review highlights the lack of quality of life data in trials involving chemotherapy treatment for SCLC. With poor long-term survival associated with both treatment groups, the issue of the quality of the survival period takes on even more significance. It would be beneficial for future trials in this area to include a quality of life assessment.
Plain language summary
A comparison of platinum-based and non-platinum-based chemotherapy regimens for the treatment of small cell lung cancer
Small cell lung cancer (SCLC) is a very aggressive form of cancer due to early metastasis. As a result, chemotherapy forms the mainstay of treatment. This review compared platinum-based chemotherapy regimens and non-platinum-based chemotherapy regimens for the treatment of SCLC. The results show that there is no significant difference between platinum-based and non-platinum-based chemotherapy regimens in terms of survival and overall (complete and partial) tumour response. However, platinum-based regimens did have better complete tumour response rates. Platinum-based regimens also had higher levels of nausea and vomiting, anaemia and thrombocytopenia toxicity. Further research into the quality of life associated with these treatment regimens is needed.
搜尋從 1966 年到 2007 年 4 月之間，刊載於CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE, EMBASE 與 CINAHL 等生物醫學資料庫上之文獻，我們也同時也手動搜尋了相關資源文獻。
本系統性回顧包含29個試驗，5530個病人。在治療組之間，6個月、12個月、24個月存活率與整體腫瘤反應率都沒有統計上的差異。但是在含白金類化療藥物之組有較高的機率達到完全反應 (complete response)，但也會有較高的比例產生的噁心、嘔吐、貧血與血小板降低等不良反應。其中有三個研究有呈現生活品質相關數據，但呈現數據並不完整，因此未納入統合分析裡。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
含白金類化療藥物與不含白金類化療藥物在小細胞肺癌的治療比較： 小細胞肺癌是一種進展快速而易早期遠處轉移的癌症，因此化學治療是最主要的治療。本系統性回顧在比較含白金類化療藥物與不含白金類化療藥物在小細胞肺癌的治療。結果顯示含白金類化療藥物與不含白金類化療藥物對於存活率與整體腫瘤反應率 (完全反應與部份反應) 並沒有統計上的差異，但是含白金類化療藥物有較佳之腫瘤完全反應率，但也伴隨較嚴重的噁心、嘔吐、貧血與血小板降低等藥物毒性。未來有需要針對治療藥物相關之生活品質從事進一步之研究。