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Meta-analyses of clinical trials in patients with non-small cell lung cancer. Minireview
Abstract:
Currently lung cancer is the most common worldwide cause of major cancer incidence and mortality. The treatment outcome is poor and there are still many questions which remain unanswered such as the interest of the best treatment schedule. To approach the answer what is the best treatment for patients with non-small cell lung cancer (NSCLC) we made a review of the published meta-analyses. Meta-analysis is a systematic approach to identification and abstraction of critical information from different randomized, controlled trials. The review of meta-analyses of clinical trials we had made showed that --in radically operated patients the postoperative radiotherapy should be detrimental if standard fields are used; postoperative chemotherapy with regimens based on cisplatin has an absolute benefit of 5% at 5 years survival; we can improve the survival of patients with locally advanced NSCLC using chemoradiation comparing to radiotherapy alone; chemotherapy with cisplatin can prolong the survival and improve the quality of life in patients with advanced NSCLC; platinum-based doublets remain the standard regimen in patients with advanced NSCLC; there is a slight but significant improvement in efficacy of gemcitabine plus platinum agent when compared with other platinum based comparators in regard to the survival and time to disease progression. In our dealing with NSCLC patients there are still many controversial opinions, and the meta-analyses are seldom the only way to find more effective treatment regimen, while the improvement in lung cancer treatment is a story of small steps.
Insights
For non-small cell lung cancer (NSCLC), reviews of meta-analyses suggest postoperative radiotherapy may be detrimental. Chemotherapy, particularly cisplatin-based regimens, offers survival benefits for advanced NSCLC patients.
Area of Science:
- Oncology
- Pulmonology
- Clinical Trials Research
Background:
- Non-small cell lung cancer (NSCLC) is a leading cause of cancer incidence and mortality globally.
- Optimal treatment strategies for NSCLC remain incompletely defined, impacting patient outcomes.
- Existing research presents numerous unanswered questions regarding the most effective treatment schedules.
Purpose of the Study:
- To systematically review published meta-analyses to determine the best treatment for non-small cell lung cancer (NSCLC) patients.
- To synthesize evidence from randomized controlled trials to inform clinical decision-making in NSCLC management.
Main Methods:
- Conducted a comprehensive review of existing meta-analyses of randomized controlled trials in non-small cell lung cancer (NSCLC).
- Analyzed data to assess the efficacy and impact of various treatment modalities, including surgery, radiotherapy, and chemotherapy.
Main Results:
- Postoperative radiotherapy with standard fields may be detrimental in radically operated patients.
- Postoperative chemotherapy with cisplatin-based regimens shows a 5% absolute survival benefit at 5 years.
- Chemoradiation improves survival over radiotherapy alone for locally advanced NSCLC; cisplatin-based chemotherapy prolongs survival and improves quality of life in advanced NSCLC.
- Platinum-based doublets are the standard for advanced NSCLC, with gemcitabine plus a platinum agent offering a slight but significant survival advantage over other platinum comparators.
Conclusions:
- Treatment decisions for NSCLC involve ongoing controversies, with meta-analyses providing valuable but not always definitive answers.
- Incremental improvements in lung cancer treatment are achieved through careful evaluation of evidence, highlighting the importance of continued research.
- Cisplatin-based chemotherapy and chemoradiation represent key advancements in managing advanced and locally advanced NSCLC, respectively.
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