title: Meta-analysis to assess the efficacy and toxicity of docetaxel-based doublet compared with docetaxel alone for patients with advanced NSCLC who failed first-line treatment.
abstract: OBJECTIVE
  The benefit of docetaxel-based therapy in the second-line treatment of advanced non-small cell lung cancer (NSCLC) is still unclear. The goal of this meta-analysis was to assess the efficacy and toxicity of docetaxel-based doublet compared with docetaxel alone for patients with advanced NSCLC who failed to improve with first-line treatment.
  
  
  METHODS
  Several databases were searched, including PubMed, Embase, and the Cochrane databases. The end points were overall survival, progression-free survival (PFS), objective response rate, disease control rate, and grade 3 or 4 adverse events. Data were extracted from the studies by 2 independent reviewers. The meta-analysis was performed by using Review Manager version 5.2. The pooled hazard ratio (HR) or odds ratio (OR) and 95% CIs were calculated by using fixed or random effects models depending on the heterogeneity of the included trials.
  
  
  RESULTS
  Twelve eligible trials involving 2680 patients were identified. The intention-to-treatment analysis found that docetaxel-based therapy significantly improved overall survival (HR, 0.89 [95% CI, 0.83-0.96]; P < 0.01), PFS (HR, 0.79 [95% CI, 0.71-0.89]; P < 0.01), objective response rate (OR, 1.73 [95% CI, 1.37-2.18; P < 0.01), and disease control rate (OR, 1.30 [95% CI, 1.09-1.55]; P < 0.01). In addition, a subgroup analysis based on type of combined drug showed that there were significant improvement in PFS and overall survival in combining docetaxel with targeted therapy. In addition, a higher incidence of grade 3 or 4 diarrhea and thrombocytopenia was observed in docetaxel-based doublet therapy.
  
  
  CONCLUSIONS
  Based on the available evidence, docetaxel-based doublet therapy seems superior to docetaxel monotherapy as a second-line treatment for advanced NSCLC. More studies should focus on combining docetaxel with targeted therapy to identify patients who will most likely benefit from the appropriate combination targeted therapy.
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jin
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Hong
authors.affiliation: Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China. Electronic address: yu_xinm@sina.cn.
authors.forename: Xinmin
authors.initials: X
authors.lastname: Yu
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003967:Diarrhea / Q000139:chemically induced; D018572:Disease-Free Survival; D000077143:Docetaxel; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D019233:Retreatment; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel
keywords: docetaxel monotherapy; docetaxel-based doublet; non–small cell lung cancer; second-line therapy