title: A systematic review of the clinical effectiveness of first-line chemotherapy for adult patients with locally advanced or metastatic non-small cell lung cancer.
abstract: Our aim was to evaluate the clinical effectiveness of chemotherapy treatments currently licensed in Europe and recommended by the National Institute for Health and Care Excellence (NICE) for the first-line treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). A systematic search of MEDLINE, EMBASE and the Cochrane Library for randomised controlled trials (RCTs) published from 2001 to 2010 was carried out. Relative treatment effects for overall survival (OS) and progression-free survival (PFS) were estimated using standard meta-analysis and mixed treatment comparison methodology. A total of 23 RCTs were included: 18 trials compared platinum-based chemotherapy, two compared pemetrexed and three compared gefitinib. There are no statistically significant differences in OS between any of the four third-generation chemotherapy regimens. There is statistically significant evidence that pemetrexed+platinum increases OS compared with gemcitabine+platinum. There are no statistically significant differences in OS between gefitinib and docetaxel+platinum or between gefitinib and paclitaxel+platinum. There is a statistically significant improvement in PFS with gefitinib compared with docetaxel+platinum and gefitinib compared with paclitaxel+platinum. Due to reduced generic pricing, third-generation chemotherapy regimens (except vinorelbine) are still competitive options for most patients. This research provides a comprehensive evidence base, which clinicians and decision-makers can use when deciding on the optimal first-line chemotherapy treatment regimen for patients diagnosed with locally advanced or metastatic NSCLC.
authors: Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
authors: Gerlinde
authors: G
authors: Pilkington
authors: Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
authors: Angela
authors: A
authors: Boland
authors: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: Tamara
authors: T
authors: Brown
authors: Covance Clinical Development Services, Maidenhead, UK.
authors: James
authors: J
authors: Oyee
authors: Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
authors: Adrian
authors: A
authors: Bagust
authors: Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool, UK.
authors: Rumona
authors: R
authors: Dickson
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000191:economics / Q000556:secondary*; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Lung Cancer; Lung Cancer Chemotherapy; Non-Small Cell Lung Cancer