Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer

A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials

Sarah Burdett, S. Burdett, R. Stephens, L. Stewart, J. Tierney, A. Auperin, T. Le Chevalier, C. Le Pechoux, J. P. Pignon, R. Arriagada, J. Higgins, D. Johnson, J. Van Meerbeeck, M. Parmar, R. Souhami, D. Bell, G. Cartei, Y. Cormier, M. Cullen, P. Ganz & 10 others C. Gridelli, S. Kaasa, E. Quoix, E. Rapp, L. Seymour, S. Spiro, N. Thatcher, D. Tummarello, C. Williams, I. Williamson

Research output: Contribution to journalArticle

454 Citations (Scopus)

Abstract

Purpose: Since our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non-small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. Methods: Systematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). Results: Data were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95% CI, 0.71 to 0.83; P ≤ .0001), equivalent to a relative increase in survival of 23% or an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29%. There was no clear evidence that this effect was influenced by the drugs used (P = .63) or whether they were used as single agents or in combination (P = .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. Conclusion: This MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.

Original languageEnglish (US)
Pages (from-to)4617-4625
Number of pages9
JournalJournal of Clinical Oncology
Volume26
Issue number28
DOIs
StatePublished - Oct 1 2008

Fingerprint

Non-Small Cell Lung Carcinoma
Meta-Analysis
Randomized Controlled Trials
Drug Therapy
Survival
Demography
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer : A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials. / Burdett, Sarah; Burdett, S.; Stephens, R.; Stewart, L.; Tierney, J.; Auperin, A.; Le Chevalier, T.; Le Pechoux, C.; Pignon, J. P.; Arriagada, R.; Higgins, J.; Johnson, D.; Van Meerbeeck, J.; Parmar, M.; Souhami, R.; Bell, D.; Cartei, G.; Cormier, Y.; Cullen, M.; Ganz, P.; Gridelli, C.; Kaasa, S.; Quoix, E.; Rapp, E.; Seymour, L.; Spiro, S.; Thatcher, N.; Tummarello, D.; Williams, C.; Williamson, I.

In: Journal of Clinical Oncology, Vol. 26, No. 28, 01.10.2008, p. 4617-4625.

Research output: Contribution to journalArticle

Burdett, S, Burdett, S, Stephens, R, Stewart, L, Tierney, J, Auperin, A, Le Chevalier, T, Le Pechoux, C, Pignon, JP, Arriagada, R, Higgins, J, Johnson, D, Van Meerbeeck, J, Parmar, M, Souhami, R, Bell, D, Cartei, G, Cormier, Y, Cullen, M, Ganz, P, Gridelli, C, Kaasa, S, Quoix, E, Rapp, E, Seymour, L, Spiro, S, Thatcher, N, Tummarello, D, Williams, C & Williamson, I 2008, 'Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials', Journal of Clinical Oncology, vol. 26, no. 28, pp. 4617-4625. https://doi.org/10.1200/JCO.2008.17.7162
Burdett, Sarah ; Burdett, S. ; Stephens, R. ; Stewart, L. ; Tierney, J. ; Auperin, A. ; Le Chevalier, T. ; Le Pechoux, C. ; Pignon, J. P. ; Arriagada, R. ; Higgins, J. ; Johnson, D. ; Van Meerbeeck, J. ; Parmar, M. ; Souhami, R. ; Bell, D. ; Cartei, G. ; Cormier, Y. ; Cullen, M. ; Ganz, P. ; Gridelli, C. ; Kaasa, S. ; Quoix, E. ; Rapp, E. ; Seymour, L. ; Spiro, S. ; Thatcher, N. ; Tummarello, D. ; Williams, C. ; Williamson, I. / Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer : A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials. In: Journal of Clinical Oncology. 2008 ; Vol. 26, No. 28. pp. 4617-4625.
@article{5e5a71834ae34f18914034ad545de786,
title = "Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials",
abstract = "Purpose: Since our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non-small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. Methods: Systematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). Results: Data were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95{\%} CI, 0.71 to 0.83; P ≤ .0001), equivalent to a relative increase in survival of 23{\%} or an absolute improvement in survival of 9{\%} at 12 months, increasing survival from 20{\%} to 29{\%}. There was no clear evidence that this effect was influenced by the drugs used (P = .63) or whether they were used as single agents or in combination (P = .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. Conclusion: This MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.",
author = "Sarah Burdett and S. Burdett and R. Stephens and L. Stewart and J. Tierney and A. Auperin and {Le Chevalier}, T. and {Le Pechoux}, C. and Pignon, {J. P.} and R. Arriagada and J. Higgins and D. Johnson and {Van Meerbeeck}, J. and M. Parmar and R. Souhami and D. Bell and G. Cartei and Y. Cormier and M. Cullen and P. Ganz and C. Gridelli and S. Kaasa and E. Quoix and E. Rapp and L. Seymour and S. Spiro and N. Thatcher and D. Tummarello and C. Williams and I. Williamson",
year = "2008",
month = "10",
day = "1",
doi = "10.1200/JCO.2008.17.7162",
language = "English (US)",
volume = "26",
pages = "4617--4625",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "28",

}

TY - JOUR

T1 - Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer

T2 - A systematic review and meta-analysis of individual patient data from 16 randomized controlled trials

AU - Burdett, Sarah

AU - Burdett, S.

AU - Stephens, R.

AU - Stewart, L.

AU - Tierney, J.

AU - Auperin, A.

AU - Le Chevalier, T.

AU - Le Pechoux, C.

AU - Pignon, J. P.

AU - Arriagada, R.

AU - Higgins, J.

AU - Johnson, D.

AU - Van Meerbeeck, J.

AU - Parmar, M.

AU - Souhami, R.

AU - Bell, D.

AU - Cartei, G.

AU - Cormier, Y.

AU - Cullen, M.

AU - Ganz, P.

AU - Gridelli, C.

AU - Kaasa, S.

AU - Quoix, E.

AU - Rapp, E.

AU - Seymour, L.

AU - Spiro, S.

AU - Thatcher, N.

AU - Tummarello, D.

AU - Williams, C.

AU - Williamson, I.

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Purpose: Since our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non-small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. Methods: Systematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). Results: Data were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95% CI, 0.71 to 0.83; P ≤ .0001), equivalent to a relative increase in survival of 23% or an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29%. There was no clear evidence that this effect was influenced by the drugs used (P = .63) or whether they were used as single agents or in combination (P = .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. Conclusion: This MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.

AB - Purpose: Since our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non-small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. Methods: Systematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). Results: Data were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95% CI, 0.71 to 0.83; P ≤ .0001), equivalent to a relative increase in survival of 23% or an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29%. There was no clear evidence that this effect was influenced by the drugs used (P = .63) or whether they were used as single agents or in combination (P = .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. Conclusion: This MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.

UR - http://www.scopus.com/inward/record.url?scp=53749097825&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=53749097825&partnerID=8YFLogxK

U2 - 10.1200/JCO.2008.17.7162

DO - 10.1200/JCO.2008.17.7162

M3 - Article

VL - 26

SP - 4617

EP - 4625

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 28

ER -