Does maintenance/consolidation chemotherapy have a role in the management of small cell lung cancer (SCLC)? A metaanalysis of the published controlled trials.
BACKGROUND
The role of maintenance/consolidation chemotherapy was assessed in the management of small cell lung cancer (SCLC) via a metaanalytic approach.


METHODS
The Medline and Cochrane databases were searched for relevant randomized clinical trials that compared maintenance chemotherapy with follow-up. Quality of trials was assessed by European Lung Cancer Working Party (ELCWP) score. Odds ratios and rate differences were used as the effect size. Mantel-Haenszel tests with fixed and random effect models were conducted for 1- and 2-year overall survival (OAS) and progression-free survival (PFS).


RESULTS
Fourteen relevant randomized clinical trials to date, encompassing 2550 patients, with trial sizes ranging from 36 to 610, were identified. Both 1- and 2-year mortality were reduced with maintenance/consolidation chemotherapy. With the fixed model, odds ratios for 1- and 2-year OAS were 0.67 (95% confidence interval [CI] = 0.56-0.79), P < 0.001, and also 0.67 (95% CI = 0.53-0.86), P < 0.001. Likewise, 1- and 2-year PFS were better with maintenance/consolidation chemotherapy, with odds ratios of 0.49 (95% CI = 0.37-0.63), P < 0.001, and 0.64 (95% CI = 0.45-0.92), P < 0.015. The random model gave similar results. In accordance, maintenance chemotherapy improved 1- and 2-year OAS by 9% (from 30-39%) and 4% (from 10-14%), respectively. Similarly, 1- and 2-year PFS were also improved.


CONCLUSIONS
Maintenance/consolidation chemotherapy improves survival in SCLC. New randomized clinical trials are needed to further refine the place of this approach in the management of SCLC.
Bozcuk
Hakan
H
Akdeniz University Medical Faculty, Department of Internal Medicine, Division of Medical Oncology, Antalya, Turkey. hbozcuk@akdeniz.edu.tr
Artac
Mehmet
M
Ozdogan
Mustafa
M
Savas
Burhan
B
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018288:Carcinoma, Small Cell / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis