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
Article first published online: 18 DEC 2012
© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 12, pages 1297–1309, December 2012
How to Cite
Jiang, L., Yang, K.-H., Guan, Q.-L., Mi, D.-H. and Wang, J. (2012), 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. Internal Medicine Journal, 42: 1297–1309. doi: 10.1111/j.1445-5994.2012.02821.x
Conflict of interest: None.
- Issue published online: 18 DEC 2012
- Article first published online: 18 DEC 2012
- Accepted manuscript online: 25 APR 2012 05:10AM EST
- Manuscript Accepted: 15 MAR 2012
- Manuscript Received: 28 JUN 2011
- extensive-stage small-cell lung cancer;
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.
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.
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.
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.