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Platinum versus non-platinum chemotherapy regimens for small cell lung cancer

  • Review
  • Intervention

Authors


Abstract

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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.

摘要

背景

含白金類(Platinum) 與不含白金類化療藥物配方對小細胞肺癌的治療

小細胞肺癌是一種快速生長的癌症,其特色為早期遠處轉移。因此化學治療是最主要的治療方式。目前已有相當多不同的含白金類化療藥物與不含白金類化學藥物配方用於小細胞肺癌的治療,但其結果卻有所不同。本回顧性文獻之目的在於分析這些不同試驗之資料並比較它們的療效。

目標

評估含白金類與不含白金類化療藥物配方對於小細胞肺癌治療的存活率、腫瘤反應率、藥物毒性與生活品質。

搜尋策略

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。

選擇標準

所有隨機對照試驗中,經細胞病理學或組織病理學確診的小細胞肺癌病人,至少一組使用含白金類化療藥物與其他組使用不含白金類化療藥物之試驗即納入選擇。

資料收集與分析

兩位作者分別評估搜尋的資料,包括研究方法的品質與紀錄後續追蹤的結果:存活率、腫瘤反應率、藥物毒性與生活品質等。我們將所有研究的存活率、腫瘤反應率與藥物毒性進行整合分析 (metaanalysis)。

主要結論

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。

作者結論

含白金類化療藥物比不含白金類化療藥物對於存活率與整體腫瘤反應率在統計上並無顯著益處,但是含白金類化療藥物可以增加腫瘤完全反應率,其代價是有較高的藥物不良反應率,包括噁心、嘔吐、貧血與血小板降低。這些數據顯示不含白金類化療藥物之治療利益與藥物不良反應之風險評估上較佔優勢。本系統性回顧強調在這些研究小細胞肺癌治療的資料中缺乏生活品質的數據,由於各治療組之間的長期存活率都不高,在所剩不長的存活時間內的生活品質就顯得格外重要。未來的研究多注意生活品質的評估將對病人大有助益。

翻譯人

本摘要由臺北榮民總醫院吳東翰翻譯。

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

總結

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。

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.

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