Impact of Third‐Generation Drugs on the Activity of First‐Line Chemotherapy in Advanced Non‐Small Cell Lung Cancer: A Meta‐Analytical Approach

• Published in: The oncologist (Dayton, Ohio) Vol. 14; no. 5; pp. 497 - 510
• Main Authors: Grossi, Francesco, Aita, Marianna, Defferrari, Carlotta, Rosetti, Francesco, Brianti, Annalisa, Fasola, Gianpiero, Vinante, Orazio, Pronzato, Paolo, Pappagallo, Giovanni
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01.05.2009
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - drug therapy; Disease Progression; Docetaxel; Female; Gemcitabine; Humans; Lung Neoplasms - drug therapy; Male; Meta‐analysis; Middle Aged; Non‐small‐cell lung carcinoma; Paclitaxel; Randomized Controlled Trials as Topic; Vinorelbine
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2008-0260

Background. The therapeutic equivalence of different third‐generation agents in the first‐line treatment of advanced non‐small cell lung cancer (NSCLC) has long been accepted, although recent studies seem to suggest some superiority of gemcitabine‐ or docetaxel‐containing regimens over other third‐generation doublets. Objective. To assess the relative impact of different third‐generation drugs on the activity of first‐line chemotherapy in advanced non‐small cell lung cancer by considering both response and progressive disease (PD) rates as outcome measures. Methods. Published and unpublished data were collected from randomized trials comparing a gemcitabine‐, docetaxel‐, vinorelbine‐ or paclitaxel‐containing regimen with one or more gemcitabine‐, docetaxel‐, vinorelbine‐ or paclitaxel‐free combinations. For each study, 2 × 2 tables were constructed for both response and immediate progression. Pooled odds ratios were calculated using a general variance‐based method. Results Forty‐five trials (11,867 patients) were eligible. The odds of obtaining an objective response to treatment were similar across different regimens. Gemcitabine‐based chemotherapy was associated with a 14% lower risk for immediate progression, whereas patients receiving paclitaxel showed a 22% higher risk for having PD as the best response. Docetaxel treatment provided a nonsignificant 9% lower odds for progression. Conclusions. These data demonstrate that different third‐generation regimens have comparable activity in chemotherapy‐naïve patients with advanced NSCLC. Gemcitabine‐based chemotherapy provides better disease control, whereas the risk for immediate progression is significantly higher when paclitaxel‐containing regimens are used. This study assessed the relative impact of third‐generation drugs in first‐line chemotherapy for advanced non‐small cell lung cancer as measured by both response and progressive disease rates. The study found the agents to produce comparable response rates; however, paclitaxel‐based third‐generation regimens were associated with a significantly higher risk for immediate progression, whereas gemcitabine‐containing regimens provided better disease control.