ELCC 2014 News: A Meta-Analysis of Platinum-Based vs. Single Agent Chemotherapy in NSCLC Patients with Performance Status 2

Literature based meta-analysis favours platinum-based combination regimens

A literature-based meta-analysis of randomised trials comparing platinum-based doublets and single-agent chemotherapy, performed by Prof. Christian Rolfo of Phase I - Early Clinical Trials Unit, Antwerp University Hospital in Edegem, Belgium and colleagues from Italy, suggests that carboplatin-based combination regimens are a feasible treatment option in first-line therapy of wild-type patients with non-small-cell lung cancer (NSCLC) with performance status (PS) 2. The results were presented in a general poster session at the 4th European Lung Cancer Conference (26-29 March 2014, Geneva, Switzerland).

Platinum-based doublet chemotherapy is still the standard first-line treatment for most epidermal growth factors receptor (EGFR) wild-type NSCLC patients with PS 0-1. However, the treatment of patients with PS2 patients is still somehow controversial in routine practice. The current ESMO guidelines for diagnosis, treatment and follow-up of metastatic NSCLC states that single-agent chemotherapy with gemcitabine, vinorelbine, and taxanes represents an option and that platinum-based combinations may also be considered as an alternative treatment.

Superiority of carboplatin and paclitaxel combination over single-agent therapy has been identified in a subgroup analysis within large phase III trials, with an acceptable toxicity profile. A recent prospective phase III trial with 217 patients randomised between single-agent pemetrexed vs. carboplatin/pemetrexed showed a strong benefit in overall survival for the platinum doublet.

Literature based meta-analysis in PS2 patients

abstract-105P-ELCC2014

Flow-chart of trials selection.
© Christian Rolfo

The current meta-analysis aimed to review all randomised trials that compared platinum-based doublets and single-agent therapy in NSCLC PS2 patients. The authors collected data by searching in PubMed and Cochrane Library for all published randomised trials that compared efficacy and safety of platinum-based doublets to single-agents in untreated NSCLC patients. The studies were either completely or partially dedicated to PS2 setting.

They calculated pooled overall responses for the one-year survival rate, overall response rate (ORR), and grade 3-4 haematologic toxicities. From 1367 studies, five eligible trials (with a total of 620 NSCLC PS2 patients) were selected.

Pooled analysis showed a significant improvement in ORR (OR: 3,243; 95% CI: 1,883-5,583) and one-year survival rate (OR: 1,906; 95% CI: 1,281-2,836) in favour of platinum doublet chemotherapy.

Haematologic toxicity data were available from 4 studies. Grade 3-4 anaemia, neutropenia, and thrombocytopenia were observed more frequently in patients receiving platinum.

The authors concluded that their analysis suggests that platinum-based combination regimens are superior to single-agent chemotherapy, both in terms of ORR and survival rate with increase of severe haematological toxicities. Carboplatin-based combination appears a feasible treatment option in first-line therapy of wild-type NSCLC patients with PS2.

The authors underlined the need to better understand which factors induce a worse PS, e.g. comorbidities or tumour burden. It is of paramount importance to select a favourable subgroup of patients who could better tolerate platinum-based doublet chemotherapy.

Reference

Abstract 105p: A literature-based meta analysis about the comparison between platinum-based doublet and single agent chemotherapy in PS 2 NSCLC patients.  View the abstract on OncologyPRO

All authors declared no conflicts of interest.

The  European Lung Cancer Conference (ELCC) is organised by the  European Society for Medical Oncology (ESMO) and the  International Association for the Study of Lung Cancer (IASLC). During the four-day programme, attendees benefit from educational and scientific updates provided by thoracic oncology specialists on different multidisciplinary topics important for research and clinical practice in the field of lung cancer.