Platinum-doublet chemotherapy as second-line treatment for relapsed patients with small-cell lung cancer: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée entre 2011 et 2020 (10 études), cette méta-analyse évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité de chimiothérapies à base de doublets de sels de platine en traitement de deuxième ligne chez des patients atteints d'un cancer du poumon à petites cellules récidivant
Objective : Optimal second-line chemotherapy for patients with relapsed small-cell lung cancerremains debatable. In addition to topotecan or amrubicin monotherapy, re-challengewith first-line platinum-doublets have been commonly used. In this study, we investigated whether platinum-doublets are suitable as second-line treatment for relapsed small-celllung cancer. Materials and methods : Studies that enrolled relapsed small-cell lung cancer and compared platinum-doublets with non-platinum-based regimens for second-line treatment were identified using PubMedand EMBASE. A meta-analysis was conducted to calculate the relative risk of objectiveresponse rate and disease control rate of the second-line chemotherapy. Subgroup analyseswere conducted to focus on comparison with standard second-line regimens and sensitive relapse. Progression-free and overall survival, and adverse events were systematicallyreviewed. Results : Ten studies published between 2011 and 2020 were included in our analysis with a total of 1,222 patients: 438 treated with platinum-doublets and 784 with non-platinum-basedregimens. The objective response rates for second-line platinum-doublet and non-platinum regimens were 47.3% [95% CI: 40.5-54.0] and 31.5% [95% CI: 22.2-40.8], respectively.
Patientstreated with platinum-doublets had a significantly higher objective response ratethan patients with non-platinum-based regimens (RR [95% CI]: 1.527 [1.100-2.121], p = 0.011), as well as disease control rate (RR [95% CI]: 1.152 [1.052-1.262], p = 0.002). In a subgroup analysis comparing platinum-doublets with topotecan or amrubicin,patients treated with platinum-doublets had significantly higher objective responserate and disease control rate (RR [95% CI]: 1.663 [1.055-2.619], p = 0.028 and 1.170 [1.021-1.340], p = 0.023 respectively). Progression-free and overall survival appeared consistentwith the tumor responses. Adverse events associated with platinum-doublets appearedacceptable compared with the monotherapies. Conclusion : Platinum-doublet chemotherapy as second-line treatment for patients with relapsed small-cell lung cancer can be considered as a reasonable option in comparison with non-platinum regimens.
Lung Cancer 2021