title: Second-line treatments in non-small cell lung cancer. A systematic review of literature and metaanalysis of randomized clinical trials.
abstract: BACKGROUND
  To assess the efficacy of second-line treatments in non-small cell lung cancer (NSCLC).
  
  
  METHODS
  A systematic review of literature with metaanalysis of randomized clinical trials (RCTs) was independently performed by three authors. A primary analysis included all RCTs comparing any approach (chemotherapy or therapy with epidermal growth factor receptor [EGFR] inhibitors) with placebo; a secondary analysis included all RCTs comparing any treatment with docetaxel therapy every 3 weeks. The 1-year survival rate (SR) of the primary analysis was the primary outcome of the study; the 1-year SR of the secondary analysis, response rate (RR), and time to progression of primary and secondary analyses were the secondary end points.
  
  
  RESULTS
  Fourteen RCTs met the selection criteria. The outcomes of 2,627 and 5,952 patients were analyzed in the primary and secondary analysis, respectively. A significant heterogeneity was documented in the primary analysis for 1-year SR with odd ratio [OR] = 0.763 (p = 0.029). No heterogeneity was documented for RR in the primary analysis, with OR = 0.165 (p < 0.001). A modest heterogeneity was documented in the secondary analysis for 1-year SR and RR, with 1-year SR OR = 0.924 (p = 0.122) and RR OR = 1.069 (p = 0.643).
  
  
  CONCLUSIONS
  Second-line treatments in NSCLC seem to improve the main outcomes better than supportive care. Docetaxel administration every 3 weeks probably remains the "gold standard" because at present the data in literature are not enough to support a greater efficacy of other alternative options. Further trials are needed to identify a clinical and biological profile that could predict the response to treatments and a criterion to select the patients to be treated with chemotherapy or EGFR inhibitors.
authors.affiliation: Department of Oncology, City Hospital, Rimini, Italy. Electronic address: dtassinari@rimini.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Tassinari
authors.affiliation: Institute of Research and Study of Tumours of Romagna, Meldola, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
authors.affiliation: Department of Internal Medicine, Arcispedale S. Anna, Ferrara, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Sartori
authors.affiliation: Department of Oncology, City Hospital, Rimini, Italy.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Tamburini
authors.affiliation: Department of Oncology, City Hospital, Rimini, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Santelmo
authors.affiliation: Department of Internal Medicine, Arcispedale S. Anna, Ferrara, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tombesi
authors.affiliation: Department of Pneumology, City Hospital, Riccione, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lazzari-Agli
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000077143:Docetaxel; D004334:Drug Administration Schedule; D066246:ErbB Receptors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D043823:Taxoids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D066246:ErbB Receptors