Chemotherapy (anticancer drugs) prolongs survival in patients with advanced small cell lung cancer

Pelayo Alvarez M, Gallego Rubio Ó, Bonfill Cosp X, Agra Varela Y

Published Online:

October 7, 2009

SmalI cell lung cancer accounts for nearly a quarter of all new cases of lung cancer. This cancer is often diagnosed after it has spread to the brain, liver, bone or bone marrow and most patients die in the first year after diagnosis. This review found that chemotherapy (anticancer drugs) prolonged survival in patients with advanced small cell lung cancer, both at diagnosis and at relapse in comparison with placebo and best supportive care, although the effect of this treatment on quality of life is unknown when used as first therapy. Further research is needed in patients with poor prognosis.

Abstract (click to read)

Background:

Combination chemotherapy has been the mainstay of treatment for extensive stage small celI lung cancer (SCLC) over the last 30 years even though it only gives a short prolongation in median survival time. The main goal for these patients should be palliation with the aim of improving their quality of life.

Objectives:

To evaluate the effectiveness of chemotherapy in extensive SCLC compared with best supportive care (BSC) or placebo treatment.

Search strategy:

MEDLINE (1966 to July 2008), EMBASE (1974 to week 31, 2008), and the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2008). Experts in the field were contacted.

Selection criteria:

Randomised controlled trials in which any chemotherapy treatment was compared with placebo or BSC in patients with extensive SCLC, as first or second therapy at relapse.

Data collection and analysis:

Two authors independently extracted data and assessed study quality. We resolved disagreements by discussion. Additional information was obtained from one study author.

Main results:

Two studies were included for first-line chemotherapy. A total of 65 patients were randomised to receive either placebo or ifosfamide. Ifosfamide gave an extra mean survival of 78.5 days compared with placebo. Partial tumour response was greater with the active treatment. Toxicity was only seen in the chemotherapy group.

Two studies were included for second-line chemotherapy at relapse. A total of 531 patients were randomised to receive either methotrexate-doxorubicin or symptomatic treatment, or to receive oral topotecan versus BSC. The methotrexate-doxorubicin treatment gave a median survival of 63 days longer than in the symptomatic treatment group, and 21 days longer for patients allocated to receive four or eight cycles of first-line chemotherapy, respectively.

Treatment with topotecan gave a median survival of 84 days longer than in the BSC group (log-rank P = 0.01). The adjusted hazard ratio for overall survival was 0.61 (95% CI, 0.43 to 0.87). Partial or complete response in the methotrexate-doxorubicin group was 22.3%. Five patients (7%, 95% CI, 2.33 to 15.67) showed a partial response with topotecan. Toxicity was worst in the chemotherapy group. Quality of life was better in the topotecan group.

Authors' conclusions:

Chemotherapeutic treatment prolongs survival in comparison with placebo in patients with advanced SCLC. Nevertheless, the impact of first-line chemotherapy on quality of life and in patients with poor prognosis is unknown. Well-designed, controlled trials are needed to further evaluate the risks and benefits of different chemotherapeutic schedules in patients with advanced SCLC.

This record should be cited as:

Pelayo Alvarez M, Gallego Rubio Ó, Bonfill Cosp X, Agra Varela Y. Chemotherapy versus best supportive care for extensive small cell lung cancer. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD001990. DOI: 10.1002/14651858.CD001990.pub2

Assessed as up to date:

April 3, 2009

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Primary Review Group:

Lung Cancer Group

Health topics:

Cancer > Lung > Small cell

Lungs & airways > Lung cancer > Small cell

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Chemotherapy (anticancer drugs) prolongs survival in patients with advanced small cell lung cancer

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