Comparison of docetaxel- and vinca alkaloid-based chemotherapy in the first-line treatment of advanced non-small cell lung cancer: a meta-analysis of seven randomized clinical trials.
BACKGROUND
To compare the impact on overall survival (OS) of docetaxel-based chemotherapy versus vinca alkaloid-based regimens for first-line therapy of advanced non-small cell lung cancer.


METHODS
A meta-analysis of all randomized, controlled trials comparing docetaxel- and vinca alkaloid-based chemotherapy was undertaken using MEDLINE, CANCERLIT, MEDSCAPE, Google Scholar, the Cochrane Library, the National Institutes of Health randomized, controlled trials register, and conference proceedings, supplemented by information from clinical study reports. All published and unpublished randomized, controlled trials (in any language) were included. Analysis was based on pooling individual logarithms of the hazard ratio for OS and the odds ratio (OR) for safety.


RESULTS
From eight potentially eligible trials, seven were selected (n = 2867). Docetaxel was administered with a platinum agent (three trials), with gemcitabine (two trials), or as monotherapy (two trials). Vinca alkaloid (vinorelbine [six trials] and vindesine [one trial]) was administered with cisplatin (six trials) or alone (one trial). The pooled estimate for OS showed an 11% improvement in favor of docetaxel (hazard ratio = 0.89; 95% confidence interval: 0.82-0.96; p = 0.004). Sensitivity analyses considering only vinorelbine as a comparator or only the doublet regimens showed similar improvements. Grade 3/4 neutropenia and grade 3/4 serious adverse events were less frequent with docetaxel- versus vinca alkaloid-based regimens (OR = 0.59; 95% confidence interval: 0.38-0.89; p = 0.013 and OR = 0.68; 95% confidence interval: 0.55-0.84; p < 0.001, respectively).


CONCLUSIONS
According to this meta-analysis, docetaxel is superior to vinca alkaloid-based regimens in terms of OS and safety for first-line therapy of advanced non-small cell lung cancer.
Douillard
Jean-Yves
JY
Centre R. Gauducheau, St. Herblain, France. jy-douillard@nantes.fnclcc.fr
Laporte
Silvy
S
Fossella
Frank
F
Georgoulias
Vassilis
V
Pujol
Jean-Louis
JL
Kubota
Kaoru
K
Monnier
Alain
A
Kudoh
Shinzoh
S
Rubio
Jaime Ernesto
JE
Cucherat
Michel
M
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014751:Vindesine / Q000008:administration & dosage; D000077235:Vinorelbine; D000093542:Gemcitabine
D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D014747:Vinblastine; D002945:Cisplatin; D000077235:Vinorelbine; D014751:Vindesine; D000093542:Gemcitabine