Chemotherapy with cetuximab or chemotherapy alone for untreated advanced non-small-cell lung cancer: A systematic review and meta-analysis

Lin, Hao; Jiang, Jingwei; Liang, Xiaohua; Zhou, XinLi; Huang, Ruofan

doi:10.1016/j.lungcan.2010.01.009

« Previous Next »Lung Cancer
Volume 70, Issue 1 , Pages 57-62, October 2010

Chemotherapy with cetuximab or chemotherapy alone for untreated advanced non-small-cell lung cancer: A systematic review and meta-analysis

Hao Lin
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200040, China
- These two authors contribute equally to this work.
Jingwei Jiang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200040, China
- These two authors contribute equally to this work.
Xiaohua Liang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200040, China
- Corresponding author at: Department of Oncology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China. Tel.: +86 21 52887162; fax: +86 21 62489191.
XinLi Zhou
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200040, China
Ruofan Huang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200040, China

Received 18 July 2009; received in revised form 10 January 2010; accepted 12 January 2010. published online 11 February 2010.

Abstract

Purpose

To compare the efficacy and toxicities of chemotherapy plus cetuximab (Erbitux, E; E-chemo) with chemotherapy alone (chemo alone) in patients with previously untreated advanced non-small-cell lung cancer (NSCLC). The primary endpoint was overall survival; the secondary endpoints were progression-free survival, overall response rate, one-year survival and safety.

Methods

The PubMed database, the Cochrane Library, conference proceedings, database of ongoing trials and references of published trials and reviews were screened. Two reviewers independently assessed the quality of the trials and extracted data. The hazard ratios (HRs) for overall survival and progression-free survival, relative risks (RRs) for overall response rate and one-year survival, and odds ratios (ORs) for the different types of toxicity were pooled using STATA SE10.1 package.

Results

Four trials involving 2018 patients with previously untreated NSCLC were ultimately analyzed. The pooled HR for overall survival (HR, 0.87; 95%CI, 0.79–0.96; p=0.004) was in favor of E-chemo, which also gave rise to a higher overall response rate (RR, 1.19; 95%CI, 1.04–1.37; p=0.013). The analysis failed to show benefit of E-chemo in progression-free survival (HR, 0.91; 95%CI, 0.83–1.00; p=0.06) and one-year survival (RR, 1.10; 95%CI, 0.98–1.26; p=0.172). E-chemo indeed caused more grade 3/4 rash and infusion reaction (OR, 43.86; 95%CI, 12.46–154.44; p=0.000; OR, 3.69; 95%CI, 1.89–7.25; p=0.000; respectively).

Conclusion

Our data showed that the addition of cetuximab to chemotherapy would improve overall survival and overall response rate. It may provide new option for clinical treatment for untreated advanced non-small-cell lung cancer. The side effects of E-chemo are predictable and manageable.

Keywords: Carcinoma, Non-small-cell lung, Cetuximab, Chemotherapy, Meta-analysis