Cisplatin Plus Etoposide Versus Other Platin-based Regimens For Patients With Extensive Small Cell Lung Cancer: A Systematic Review

Objective To compare the efficacy and safety of patients with extensive small cell lung cancer treated with irinotecan/cisplatin(IP) versus other platin-based regimens.Methods We searched Embase(1974 to June 2008),Pubmed(1966 to June 2008),the Cochrane Library(2008 issue 2),China journal full-text database(CJFD,1994 to June 2008),Chinese scientific journal full-text database(CSJD,1989 to June 2008), Chinese Biomedicine literature database(CBM,1978 to June 2008) for randomised controlled trials comparing EP with other platin-based regimens.Two reviewers independently assessed the quality of included studies and extracted data.We analyzed the data using Review Manager(version 5.0).Results Seven trials(1460 patients) were eligible.In the trials comparing IP regimens with EP regimens(5RCTs invovling 1180 patients),there was no statistically significant difference between treatment groups in terms of one year survival rate [RR=1.22,95%CI(0.97-1.54)],two year survival rate[RR=1.91,95%CI(0.53-6.91)], however,IP regimens did have a significantly higher overall response rate[RR=1.13, 95%CI(1.03-1.25)].There was also no statistically significant difference in terms of grade 3/4 infection[RR=0.96,95%CI(0.69-1.35)],grade 3/4 nausea/vomiting[RR= 1.66,95%CI(0.98-2.81)].But grade 3/4 neutropenia[RR=0.48,95%CI(0.34-0.69)], grade 3/4 anaemia[RR=0.55,95%CI(0.35-0.88)],and grade 3/4 leukopenia[RR=0.50 95%CI,(0.39-0.64)].Although grade 3/4 thrombocytopenia[RR=0.23,95%CI (0.13-0.42)]was less frequent in IP regimen than EP regimen,grade 3/4 diarrhoea [RR=8.25,95%CI(3.00-22.67)]was more frequent in IP regimen;(2) No difference was seen between CE regimen and EP regimen in terms of overall response rate[RR=1.10,95%CI(0.81-1.48)],grade 3/4 leukopenia[RR=1.04,95%CI (0.81-1.34)],grade 3/4 neutropenia[RR=1.05,95%CI(0.97-1.14)],grade 3 anaemia [RR=1.17,95%CI(0.76-1.82)],grade 3 nausea/vomiting[RR=0.66,95%CI (0.11-3.88)],however,CE regimen did have a significantly higher rate of grade 3/4 thrombocytopenia[RR=3.56,95%CI(2.23-5.68)]and grade 3/4 infection[RR=3.56, 95%CI(2.23-5.68)].None trial presented quality of life data.Conclusion Except for IP regimens did have a significantly higher overall response rate,other platin-based regimens did not show a statistically significant benefit in survival rate or overall response rate compared with EP regimen.IP regimen has less hematologic & greater gastrointestinal toxicity with compared to EP,but is based on a small number of trials and patients,therefore,well-designed,controlled trials are needed to include a quality of life assessment and to further evaluate the risks and benefits of different chemotherapeutic schedules in patients with extensive small cell lung cancer.