Cisplatin plus etoposide versus other platin-based regimens for patients with extensive small-cell lung cancer: a systematic review and meta-analysis of randomised, controlled trials

Authors

  • L. Jiang,

    1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
    2. Department of Oncology Surgery, The Surgery, The First Hospital of Lanzhou University, Lanzhou, China
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  • K.-H. Yang,

    Corresponding author
    1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
    • Correspondence

      Ke-hu Yang, Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, 199 Dong Gang Road, Chengguan District, Lanzhou, Gansu 730000, China.

      Email: yangkehuebm2006@126.com

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  • Q.-L. Guan,

    1. Department of Oncology Surgery, The Surgery, The First Hospital of Lanzhou University, Lanzhou, China
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  • D.-H. Mi,

    1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
    2. Oncology Treatment Center, The Second Hospital of Gansu Province, Lanzhou, China
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  • J. Wang

    1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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  • Funding: None.
  • Conflict of interest: None.

Abstract

Aim

To determine whether the cisplatin plus etoposide (EP) combination was more efficacious and less toxic than other platinum-based regimens for patients with extensive-stage small-cell lung cancer.

Methods

We performed an extensive literature search (from their inception to July 2010). Two reviewers independently assessed search results and methodological quality of included studies. Pooled hazard ratios (HRs) and relative risks (RRs) were calculated according to a random-effects model.

Results

Twelve randomised, controlled trials involving seven different platinum-based chemotherapy regimens were included into this meta-analysis. The meta-analysis showed that compared with EP regimen, irinotecan plus cisplatin (IP) might decrease the risk of death (HR = 0.87, 95% confidence interval (CI) 0.78–0.97, P = 0.01) (five trials), unlike the sensitivity analysis (HR = 0.91, 95% CI 0.81–1.02, P = 0.12), progression-free survival (HR = 0.95, 95% CI 0.86–1.05, P = 0.28) and overall response rate (RR 1.08, 95% CI 0.93–1.24) that were not superior for IP. IP regimen produced more non-haematological toxicities and less haematological toxicities. One trial found that etoposide + cisplatin + epirubicin + cyclophosphamide and cisplatin + etoposide + ifosfamide regimen might prolong the overall survival respectively. Etoposide + cisplatin + epirubicin + cyclophosphamide regimen also might improve progression-free survival but with high rate of haematological toxicities. None of the other trials included in the study demonstrated a significant improvement in survival.

Conclusions

There is no strong evidence that any clinical advantage for extensive small-cell lung carcinoma patients requiring chemotherapy when comparing EP with other platin-based regimens, with exception of IP that might prolong overall survival. The decision to prescribe which chemotherapy should take into consideration both cost and treatment preference.

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