Irinotecan In The Treament Of Small Cell Lung Cancer (SCLC): A Systematic Review

ObjectiveTo evaluate the efficacy and safety of irinootecan in the treatment of small cell lung cancer(SCLC)MethodsA systematic review of all the relevant randomized(RCTs) was performed. Searches were applied to the following electronic database:Medline,Embase,CBM, CNKI,VIP Database,Cochraneliberary.Meanwhile we had checked total night journals(including the Chinese Journal of Oncology).The selection of studies,data extraction and assessment of studies quality were performed independently by two reviewers.RevMan4.2.7 software developed by the cochrane collaboration was used for meta-analysis.ResultsSeven studies involved 979 participants with small cell lung cancer.All included studies were adequate in reporting randomization,three studies were adequate in concealment of allocation and one study used double blind method(DBM). Meta-analysis based on included studies showed that response rate of IP regimen may be higher,compared with EP regimen[OR1.44,95%CI(1.00—2.08)],One year survival rate[OR1.46,95%CI(0.62-3.43)]and two year survival rate[OR1.87,95%CI(0.39-9.07)] of IP regimen had no statistic significance compared with EP regimen.Severe myelosuppression as neutropenia[OR0.11 95%CI(0.07-0.19)]anemia[OR0.58 95% CI(0.34-0.99)]and thrombopenia[OR0.19 95%CI(0.10-0.37)]was more frequent in the EP regimen than in the IP regien,and severe or lifethreatening diarrhea[OR25.28 95%CI(5.91-108.13)]was more frequent in the IP regimen than in the EP regimen; Complete response rate of IC regimen is higher compared with EC regimen[OR3.40,95%CI(1.43-8.09)],Severe or life-threatening Anemia[OR0.44, 95%CI(0.19-0.99)land Thrombocytopenia[OR0.41,95%CI(0.23-0.73)]was more frequent in the EP regimen than in the IC regien,and severe even lifethreatening diarrhea[OR6.42,95%CI(1.81-22.81)]was more frequent in the IC regimen than in the EP regimen,leucopenia[OR0.50,95%CI(0.13-1.89)]treat-related deaths[OR0.48,95% CI(0.16-1.42)]of IP regimen has no statistic significance compared with EP regimen. IPE regimen has no Significant response rate and overall survival advantage compared with IP regimen.Maintenance irinotecan therapy has no overall survival advantage.37 treat-related deaths were reported in all included studies.ConclutionsIrinootecan was an effective remedy for treatment of SCLC,combined with platin regimen had the same effect as the traditional first-line regimen,and had less myelo-suppression and more severe or lifethreatening diarrhea.Due to high risk of selection bias and detection bias of included studies,the evidence could not judge the effect of irinootecan.Our results suggested that further and larger-scale trials of the use of irinootecan will be carried in the treatment of SCLC.