CISPLATIN ETOPOSIDE STILL THE STANDARD IN SCLC

Intern Med J. 2012 Apr 25. doi: 10.1111/j.1445-5994.2012.02821.x. [Epub ahead of print]

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

Jiang L, Yang KH, Guan QL, Mi DH, Wang J.

Source

Evidence based medicine center, Schoolschool of basic medical sciences, Lanzhou university, Lanzhou, China Department of Oncology Surgery, Thesurgery, the first hospital of Lanzhou university, Lanzhou, China. Oncology treatment center, Thethe second hospital of Gansu province, Lanzhou, China.

Abstract

BACKGROUND:

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 (SCLC).

METHODS:

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

RESULTS:

12 randomized control trials (RCTs) involving 7 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%CI: 0.78-0.97, P=0.01) (5 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) were not superior for IP. IP regimen produced more haematological toxicities and less non-haematological toxicities. One trial found PCDE (etoposide+cisplatin +epirubicin+cyclophosphamide) and EPI (cisplatin+etoposide+ifosfamide) regimen might prolong the overall survival (OS), respectivly. PCDE regimen also might improve PFS 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 SCLC patients requiring chemotherapy when comparing EP with other platin-based regimens, with exception of IP might prolong OS. The decision to prescribe which chemotherapy should take into consideration both cost and treatment preference.