title: Efficacy of fourth-line chemotherapy in advanced non-small-cell lung cancer: a systematic review and pooled analysis of published studies.
abstract: There are no agents labelled for use as fourth-line therapy for non-small-cell lung cancer, even though it is currently prescribed in about 5-10% of patients. Here, we provide a pooled analysis of published studies on the efficacy of treatments in patients who have had at least three unsuccessful lines of therapy. The literature search was performed on Pubmed, EMBASE, the Web of Science, SCOPUS, CINAHL, Google Scholar and the Cochrane Library using the terms 'lung cancer' OR NSCLC AND 'fourth line'. The response rates and disease control rates were pooled using a random-effect or a fixed-effect model according to heterogeneity. Median progression-free survival and overall survival data were also collected and aggregated to obtain pooled median values of the included studies. Overall, 14 studies (673 patients), which were almost entirely published by Asian institutions, were eligible for this pooled analysis. Among these were two phase II trials and 12 retrospective cohort series. In general, the pooled overall response rate was 13.6% [95% confidence interval (CI) 10-18.3] and the pooled overall disease control rate was 47.3% (95% CI 38-56.9). The pooled median progression-free survival for these studies was 3.34 months (95% CI 2.42-4.27). The pooled median overall survival for these studies was 10.5 months (95% CI 9.57-11.52). In conclusion, for non-small-cell lung cancer patients who have undergone three or more unsuccessful lines of therapy, fourth-line treatment could be offered in select cases to those with a good performance status.
authors.affiliation: Department of Oncology, Division of Medical Oncology, Azienda Ospedaliera Treviglio, Treviglio, Bergamo, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Petrelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Coinu
authors.forename: Mary
authors.initials: M
authors.lastname: Cabiddu
authors.forename: Karen
authors.initials: K
authors.lastname: Borgonovo
authors.forename: Mara
authors.initials: M
authors.lastname: Ghilardi
authors.forename: Veronica
authors.initials: V
authors.lastname: Lonati
authors.forename: Sandro
authors.initials: S
authors.lastname: Barni
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D024221:Antineoplastic Protocols; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents