Chemotherapy plus Vandetanib or Chemotherapy Alone in Advanced Non-small Cell Lung Cancer: A Meta-analysis of Four Randomised Controlled Trials |
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| Authors: | Yong-Ying Xiao Ping Zhan Dong-Mei Yuan Hong-Bing Liu Tang-Feng Lv Yi Shi Yong Song |
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| Institution: | 1. Department of Medicine, University of Chicago Medicine & Biological Sciences, Chicago, USA;2. Department of Medicine, Duke University Medical Center, Durham, USA;3. Lung Cancer Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain;4. Thoracic Oncology Program, Vanderbilt-Ingram Cancer Center, Nashville, USA;5. Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy;6. Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA;7. Oncologia Medica, Centro Internacional de Estudios Clinicos, Santiago, Chile, USA;8. Department of Internal Medicine, Yale Comprehensive Cancer Center, New Haven, USA;9. Department of Medicine, Hospital De Madrid, Madrid, Spain;10. Research Consortium, Sarah Cannon Research Institute, Nashville, USA;11. Tennessee Oncology, PLLC, Nashville, USA;12. Department of Medical Oncology, OHC (Oncology Hematology Care), Cincinnati, USA;13. US Oncology, Cincinnati, USA;14. Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain;15. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;16. Department of Medicine, University of Washington, Seattle, USA;17. Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, USA;18. Multidisciplinary Oncology & Therapeutic Innovations Departmen, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France;19. Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France;20. Cancer Center, Massachusetts General Hospital, Boston, USA;21. Thoracic Oncology Unit and Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico;22. Thoracic Oncology Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA;23. Department of Oncolog, Division of Medical Oncology, Cross Cancer Institute, Edmonton, Canada;24. Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany;25. Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA |
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| Abstract: | AimsMost patients with advanced non-small cell lung cancer (NSCLC) require systemic chemotherapy. Vandetanib, targeting epidermal growth factor receptor and vascular endothelial growth factor receptor signalling in NSCLC, has recently been evaluated in combination chemotherapy in advanced NSCLC. However, the advantage of chemotherapy plus vandetanib over chemotherapy alone in advanced NSCLC remains largely unknown. A meta-analysis of randomised controlled trials was carried out to compare the efficacy and toxicity of chemotherapy plus vandetanib with chemotherapy alone in advanced NSCLC.Materials and methodsThe PubMed database, American Society of Clinical Oncology, European Society for Medical Oncology and the Cochrane Library and references of published trials were searched. Two reviewers independently assessed the quality of the trials. Data were extracted and the overall response rate, pooled progression-free survival, overall survival with 95% confidence intervals and main toxicity were analysed.ResultsFour randomised controlled trials involving 2160 patients with advanced NSCLC were ultimately analysed. Compared with chemotherapy alone, chemotherapy plus vandetanib significantly increased the overall response rate (relative risk = 1.96, 95% confidence interval = 1.53––2.52) and progression-free survival (hazard ratio = 0.79, 95% confidence interval = 0.71–0.87), but there was no significant difference in overall survival (hazard ratio = 0.91, 95% confidence interval = 0.79–1.03). Patients who received chemotherapy plus vandetanib had more rash, diarrhoea, hypertension and QTc prolongation (odds ratio = 2.32, 95% confidence interval = 1.93–2.79; odds ratio = 1.64, 95% confidence interval = 1.37–1.97; odds ratio = 4.08, 95% confidence interval = 2.51–6.01, odds ratio = 17.77, 95% confidence interval = 3.54–61.66, respectively), and less nausea and vomiting (odds ratio = 0.70, 95% confidence interval = 0.58–0.85; odds ratio = 0.69, 95% confidence interval = 0.55–0.86, respectively). The incidences of haemorrhage, fatigue and cough were comparable between the two groups.ConclusionsAlthough similar in overall survival, chemotherapy plus vandetanib showed particular advantages over chemotherapy alone in terms of progression-free survival and overall response rate. The toxicity was comparable between the two groups. Therefore, chemotherapy plus vandetanib might be a safe and valid therapeutic option for advanced NSCLC patients. |
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