In the Journals

Longer course of first-line therapy provided no survival benefit in NSCLC

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October 29, 2014

Patients with advanced non–small cell lung cancer treated with six cycles of platinum-based therapy demonstrated no survival advantage compared with those who underwent three or four cycles of therapy, according to results of a systematic review and meta-analysis.

Although platinum-based chemotherapy is the standard first-line treatment for patients with advanced NSCLC, the optimal number of treatment cycles has not been established, according to background information in the study.

Antonio Rossi, MD, of the division of medical oncology at S.G. Moscati Hospital in Avellino, Italy, and colleagues assessed data from five trials to compare outcomes among patients treated with six cycles of platinum-based chemotherapy (n=568) with those who underwent three or four cycles (n=571).

OS served as the primary outcome measure. Secondary outcome measures included PFS, toxicity and the proportion of patients with an objective response.

Researchers reported longer median OS among patients assigned six treatment cycles (9.54 months vs. 8.68 months; HR=0.94; 95% CI, 0.83-1.07), although the difference was not statistically significant. Researchers also reported slight heterogeneity between trials (P=.076; I2=56%).

Median PFS was significantly longer among patients treated with six cycles (6.09 months vs. 5.33 months; HR=0.79; 95% CI 0.68–0.9). Also, more patients treated with six cycles demonstrated an objective response (41.3% vs. 36.5%; P=.16).

However, incidence of grade ≥3 anemia was higher among patients assigned to the longer duration of treatment (7.8% vs. 2.9%).

“Six cycles of first-line platinum-based chemotherapy did not improve overall survival compared with three or four courses in patients with advanced non–small cell lung cancer,” Rossi and colleagues concluded. “Exploratory subgroup analyses did not show any benefit from a longer duration of treatment in any subgroup based on patient characteristics, tumor characteristics and type of response obtained. Our findings suggest that to plan fewer than six cycles of first-line platinum-based chemotherapy is a valid treatment option for these patients.”

Disclosure: The researchers report no relevant financial disclosures. 

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