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Does maintenance/consolidation chemotherapy have a role in the management of small cell lung cancer (SCLC)? A metaanalysis of the published controlled trials.

Bozcuk H, Artac M, Ozdogan M, Savas B

Akdeniz University Medical Faculty, Department of Internal Medicine, Division of Medical Oncology, Antalya, Turkey. hbozcuk@akdeniz.edu.tr

BACKGROUND: The role of maintenance/consolidation chemotherapy was assessed in the management of small cell lung cancer (SCLC) via a metaanalytic approach. METHODS: The Medline and Cochrane databases were searched for relevant randomized clinical trials that compared maintenance chemotherapy with follow-up. Quality of trials was assessed by European Lung Cancer Working Party (ELCWP) score. Odds ratios and rate differences were used as the effect size. Mantel-Haenszel tests with fixed and random effect models were conducted for 1- and 2-year overall survival (OAS) and progression-free survival (PFS). RESULTS: Fourteen relevant randomized clinical trials to date, encompassing 2550 patients, with trial sizes ranging from 36 to 610, were identified. Both 1- and 2-year mortality were reduced with maintenance/consolidation chemotherapy. With the fixed model, odds ratios for 1- and 2-year OAS were 0.67 (95% confidence interval [CI] = 0.56-0.79), P < 0.001, and also 0.67 (95% CI = 0.53-0.86), P < 0.001. Likewise, 1- and 2-year PFS were better with maintenance/consolidation chemotherapy, with odds ratios of 0.49 (95% CI = 0.37-0.63), P < 0.001, and 0.64 (95% CI = 0.45-0.92), P < 0.015. The random model gave similar results. In accordance, maintenance chemotherapy improved 1- and 2-year OAS by 9% (from 30-39%) and 4% (from 10-14%), respectively. Similarly, 1- and 2-year PFS were also improved. CONCLUSION: Maintenance/consolidation chemotherapy improves survival in SCLC. New randomized clinical trials are needed to further refine the place of this approach in the management of SCLC.

Published 14 December 2005 in Cancer, 104(12): 2650-7.
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