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Lung. 2015 Oct;193(5):805-14. doi: 10.1007/s00408-015-9758-y. Epub 2015 Jun 29.

Maintenance Therapy Improves Survival Outcomes in Patients with Advanced Non-small Cell Lung Cancer: A Meta-analysis of 14 Studies.

Author information

1
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China. lushun1964@126.com.
2
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.

Abstract

PURPOSE:

The aim was to investigate whether maintenance therapy (MT) is sufficient or not to improve overall survival (OS) and progress-free survival (PFS) of advanced non-small cell lung cancer (NSCLC) patients.

METHODS:

Randomized controlled trials (RCTs) published between 1990 and 2013 were retrieved from PubMed, EMBASE, ISTP, clinicaltrials.org, and ASCO conference proceeding. Patients' characteristics, OS, progress-free survival, and hazard ratios were extracted. Data were analyzed using RevMan 5.2. Fourteen RCTs involving 6198 individuals were included.

RESULTS:

Compared with placebo, observation or best supportive care (BSC), patients receiving single agent (SA) MT had an improved OS (hazard ratio, HR 0.85, 95% CI 0.79-0.91; p < 0.05) and PFS (HR 0.65, 95% CI 0.57-0.73; p < 0.05). In a sub-group analysis of SA MT versus placebo, observation or BSC, we found that switch MT using SA provided an improved OS (HR 0.85, 95% CI 0.79-0.91; p < 0.05). For multiple agent (MA) versus SA MT, a prolonged PFS (HR 0.68, 95% CI 0.52-0.88; p < 0.05) but not OS (HR 0.96, 95% CI 0.86-1.07; p > 0.05) was observed for MA. A significant prolonged PFS was observed in MA switch MT (HR 0.71, 95% CI 0.58-0.86; p < 0.05) versus SA MT. However, no significant improvement in OS was observed for MA versus SA MT, indicating that switch MT (HR 0.90, 95% CI 0.73-1.12; p > 0.05) and continuous MT (HR 0.98, 95% CI 0.86-1.11; p > 0.05) showed similar effect on OS.

CONCLUSION:

SA switch MT is associated with improved OS and PFS in patients with advanced NSCLC. MA switch MT is sufficient to improve PFS, but not OS.

KEYWORDS:

Advanced non-small cell lung cancer; Maintenance therapy; Meta-analysis

PMID:
26119960
DOI:
10.1007/s00408-015-9758-y
[Indexed for MEDLINE]

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