title: No Advantage in Survival With Targeted Therapies as Maintenance in Patients With Limited and Extensive-Stage Small Cell Lung Cancer: A Literature-Based Meta-Analysis of Randomized Trials.
abstract: Small cell lung cancer (SCLC) is a lethal disease with a very restricted armamentarium of active treatments. In the new era of targeted therapies, several attempts based on the combination of chemotherapy with new compounds has been made but with a low rate of success. The idea of using the new targeted therapies as maintenance treatment after their combination with chemotherapy has been pursued. The aim of the present study was to analyze the available clinical data regarding the effect of the targeted agents as maintenance therapy on survival in patients with SCLC. A literature-based meta-analysis of randomized controlled trials, in accordance with the preferences for reported items in systematic reviews and meta-analyses guidelines, was performed. PubMed, the Cochrane Library, and a search of abstracts presented at American Society of Clinical Oncology meetings were searched for relevant studies. The primary outcome was overall survival (OS). Nine studies, with a total of 1385 patients, were included. The pooled analysis revealed that the new targeted therapies did not improve survival compared with the control arm (placebo, hazard ratio, 1.02; 95% confidence interval, 0.91-1.15; P = .69). However, a small advantage in the 1-year OS rate (risk ratio, 1.21; 95% confidence interval, 0.9-1.63; P = .21) was observed. Maintenance with targeted therapies failed to improve the survival of patients with SCLC with an increased rate of toxicity. The detected survival advantage suggests that perhaps the maintenance approach could be used to increase the 1-year OS rate. However, this finding requires confirmation in further studies, perhaps of patients selected according to their tumor biologic profile.
authors.affiliation: Section of Pharmacology and University Center DIFF-Drug Innovation Forward Future, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy; US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy. Electronic address: giandomenicoroviello@gmail.com.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Roviello
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Zanotti
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Cappelletti
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Gobbi
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Senti
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bottini
authors.affiliation: US Terapia Molecolare e Farmacogenomica, Azienda Socio-Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Generali
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D060046:Maintenance Chemotherapy / Q000009:adverse effects / Q000379:methods; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: Bevacizumab; Maintenance; SCLC; Target therapy; Thalidomide