title: Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes.
abstract: OBJECTIVE
  Gemcitabine-platinum combination activity has been clearly established in a number of phase II studies. It has also been compared against other combinations in many phase III trials. It is generally believed that all such regimens have an equivalent impact on survival. This meta-analysis aims to quantify the treatment effect of gemcitabine plus a platinum agent in the treatment of advanced NSCLC and compare the combination to other regimens used globally.
  
  
  METHODS
  Data from a total of 4556 patients from 13 randomized trials investigating gemcitabine in combination with a platinum agent versus any other platinum-containing regimen were included in a meta-analysis of time-to-event outcomes.
  
  
  RESULTS
  A significant reduction in overall mortality in favor of gemcitabine-platinum regimens was observed, hazard ratio (HR) 0.90 (95% CI: 0.84-0.96) with an absolute benefit at 1 year of 3.9%. Median survival was 9.0 months for the gemcitabine-platinum regimens and 8.2 months for the comparator regimens. Sub-group analysis of the first- and second-generation platinum-based comparator regimens also indicated a significant benefit for gemcitabine-platinum regimens, HR 0.84 (CI: 0.71-0.9985). Analysis of third-generation agent plus platinum regimens showed a non-significant trend favoring gemcitabine-platinum regimens, HR 0.93 (CI: 0.86-1.01). There was a significant decrease in the risk of disease progression in favor of gemcitabine-platinum regimens, HR 0.88 (CI: 0.82-0.93). An absolute benefit of 4.2% at 1 year was estimated. Median progression-free survival was 5.1 months for gemcitabine-platinum regimens compared with 4.4 months for the comparator regimens. Sub-group analysis indicated a statistically significant progression-free survival benefit for patients assigned to gemcitabine-platinum treatment compared to first- and second-generation platinum regimens, HR 0.85 (CI: 0.77-0.94), and third-generation agent plus platinum regimens, HR 0.89 (CI: 0.82-0.96).
authors.affiliation: Institute Gustave-Roussy, 39-53 Rue Camille Desmoulins, F-94800 Villejuif, France. tle-che@igr.fr
authors.forename: T
authors.initials: T
authors.lastname: Le Chevalier
authors.forename: G
authors.initials: G
authors.lastname: Scagliotti
authors.forename: R
authors.initials: R
authors.lastname: Natale
authors.forename: S
authors.initials: S
authors.lastname: Danson
authors.forename: R
authors.initials: R
authors.lastname: Rosell
authors.forename: R
authors.initials: R
authors.lastname: Stahel
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.forename: R M
authors.initials: RM
authors.lastname: Rudd
authors.forename: J
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: N
authors.initials: N
authors.lastname: Thatcher
authors.forename: C
authors.initials: C
authors.lastname: Manegold
authors.forename: J-L
authors.initials: JL
authors.lastname: Pujol
authors.forename: N
authors.initials: N
authors.lastname: van Zandwijk
authors.forename: C
authors.initials: C
authors.lastname: Gridelli
authors.forename: J P
authors.initials: JP
authors.lastname: van Meerbeeck
authors.forename: L
authors.initials: L
authors.lastname: Crino
authors.forename: A
authors.initials: A
authors.lastname: Brown
authors.forename: P
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: M
authors.initials: M
authors.lastname: Aristides
authors.forename: J H
authors.initials: JH
authors.lastname: Schiller
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology*; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D002945:Cisplatin; D000093542:Gemcitabine