Meta-analysis Of The Efficacy And Safety Of Chemotherapy In Treating Patients With Lung Cancer

Objective Part 1. Chemotherapy plays a critical and venturous role against the co-morbidity of nonsmall cell lung cancer and interstitial lung disease(NSCLC–ILD). We performed a Bayesian meta-analysis and systematic review to evaluate the safety and efficacy of the chemotherapy in NSCLC–ILD patients. Part 2. Background and objective Regimens combined irinotecan or etoposide with cisplatin or carboplatin has been recommended as the first-line chemotherapies to address small cell lung cancer of extensive disease(ED-SCLC).Method Part 1. EMBASE, Pub Med, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov(up to January 2015). We included all study designs except case reports, all studies with NSCLC–ILD patients and all the possible chemotherapy regimens. Quality was assessed by a components approach. We derived summary estimates using Bayesian method through Win BUGS(version 1.4.3, MRC Biostatistics Unit, Cambridge, UK). Part 2. In our network meta-analysis, we synthesized the direct and indirect evidences to rank the short-term efficacy of these recommended chemotherapy regimens. Method Result Conclusion We searched databases such as EMBASE, Pub Med, CENTRAL and clinicaltrial.gov for those relevant randomized controlled trials(RCTs) compared treatment efficacy. ROB tool were used for evaluating the quality of included studies, and Stata 13.1 for statistical synthesis.Result Part 1. Seven studies involving 251 patients with NSCLC–ILD were included in the meta-analysis. The treatment response(complete remission, 0; [partial remission, 39.1%; 95% credible interval [Cr I], 32.6–45.7]; [stable disease, 36%; 95% Cr I, 29.6–42.2]; [PD, 15.4%; 95% Cr I, 11.3–19.8]; [nonevaluable, 6.4%; 95% Cr I, 2.7–10.1]; [overall response rate, 41.3%; 95% Cr I, 35.3–47.4]; [disease control rate, 77.7%; 95% Cr I, 72.2–82.7]) were comparable to that of patients with NSCLC alone; the survival outcomes(median overall survival, median progression-free survival, and 1-year survival rate) were slightly worse, especially the lower 1-year survival rate. Platinum-based doublets as first-line chemotherapy may be related to higher incidence of acute exacerbation-ILD in first line chemotherapy(AE, 8.47%; 95% Cr I, 5.04–12.6). Part 2. Our study included a total of 10 RCTs with 2378 patients. Compared with the combination of etoposide and carboplatin, complete remission rate(CR) were significantly higher in the group of irinotecan combined with carboplatin. The efficacy of irinotecan combined with carboplatin significantly superior than the combination of etoposide and cisplatin.Conclusion The data selection bias and small patient number make the meta-analysis of treatment response and conclusions generated from these data inaccurate. The present meta-analysis suggests that chemotherapy might be an effective therapy for patients with NSCLC–ILD, but it might be associated with higher incidence of acute exacerbation. Overall, we tend to estimate that the regimen of irinotecan combined with carboplatin may reach the optimal short-term efficacy in treating patients with previously untreated extensive small cell lung cancer compared with other first-line chemotherapy regimens.