Single agent maintenance therapy for advanced stage non-small cell lung cancer: A meta-analysis

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 77; no. 2; pp. 331 - 338
• Main Authors: Behera, Madhusmita, Owonikoko, Taofeek K, Chen, Zhengjia, Kono, Scott A, Khuri, Fadlo R, Belani, Chandra P, Ramalingam, Suresh S
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ireland Ltd 01.08.2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; EGFR; Erlotinib; Female; Gefitinib; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Maintenance Chemotherapy - adverse effects; Maintenance therapy; Male; Medical sciences; Middle Aged; Non-small cell lung cancer; NSCLC; Pemetrexed; Pneumology; Pulmonary/Respiratory; Quality of Life; Treatment Outcome; Tumors; Tumors of the respiratory system and mediastinum; NSCLC; Erlotinib; Maintenance therapy; Non-small cell lung cancer; Gefitinib; Pemetrexed; EGFR; Lung disease; Respiratory disease; Malignant tumor; Maintenance; non-small cell lung carcinoma; Cancerology; Treatment; Bronchus disease; Advanced stage; Cancer; Non small cell carcinoma; Pneumology
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2012.03.019

Abstract Background Maintenance therapy is a new treatment paradigm for advanced non-small cell lung cancer (NSCLC). We conducted a meta-analysis of randomized studies with single agent maintenance therapy. Methods An electronic literature search of public databases (MEDLINE, EMBASE, Cochrane library) and manual search of relevant conference proceedings was performed. A formal meta-analysis was conducted using Comprehensive Meta Analysis software (Version 2.0). Outcome data were pooled and reported as hazard ratio (HR). The primary outcome of interest was overall survival (OS) and secondary outcome was progression free survival (PFS). Results Twelve studies were included (5 meeting abstracts, 7 full manuscripts) with a total of 4286 patients (maintenance arm/control arm – 2449/1837, median age 61 years, males – 69%). The OS (HR 0.86, 95% confidence intervals [CI] 0.80–0.92; P = 0.0003) and PFS (HR 0.80, 95% CI 0.77–0.84; P < 0.0001) were superior with maintenance therapy. ‘Switch’ maintenance was associated with significant OS and PFS improvement (OS HR 0.84, 95% CI 0.77–0.91; P = 0.00026; PFS HR 0.62, 95% CI 0.57–0.67; P < 0.0001). Despite a modest improvement in PFS (HR 0.90, 95%CI 0.85–0.95; P = 0.007), “continuation” maintenance was not associated with survival benefit (HR 0.927, 95%CI 0.78–1.09; P = 0.33). Improvements in OS and PFS were observed with both EGFR-targeted agents (HR 0.83, 95% CI 0.74–0.92; P = 0.004; HR 0.64, 95% CI 0.58–0.71 P < 0.0001) and cytotoxic agents (HR 0.89, 95% CI 0.80–0.98; P = 0.018; HR 0.85, 95% CI 0.80–0.89; P < 0.0001). Conclusions Single agent maintenance therapy improves overall survival, though statistical significance was only noted with ‘switch’ maintenance.