Chemotherapy in addition to supportive care improves survival in advanced non-small-cell lung cancer: a systematic review and meta-analysis of individual patient data from 16 randomized controlled trials
Open accessAbstract
Purpose Since our individual patient data (IPD) meta-analysis (MA) of supportive care and chemotherapy for non–small-cell lung cancer (NSCLC), published in 1995, many trials have been completed. An updated, IPD MA has been carried out to assess newer regimens and determine conclusively the effect of chemotherapy. Methods Systematic searches for randomized controlled trials (RCTs) were undertaken, followed by central collection, checking, and reanalysis of updated IPD. Results from RCTs were combined to calculate individual and pooled hazard ratios (HRs). Results Data were obtained from 2,714 patients from 16 RCTs. There were 1,293 deaths among 1,399 patients assigned supportive care and chemotherapy and 1,240 among 1,315 assigned supportive care alone. Results showed a significant benefit of chemotherapy (HR, 0.77; 95% CI, 0.71 to 0.83; P ≤ .0001), equivalent to a relative increase in survival of 23% or an absolute improvement in survival of 9% at 12 months, increasing survival from 20% to 29%. There was no clear evidence that this effect was influenced by the drugs used (P = .63) or whether they were used as single agents or in combination (P = .40). Despite changes in patient demographics, the effect of chemotherapy in recent trials did not differ from those included previously (P = .77). There was no clear evidence of a difference or trend in the relative effect of chemotherapy across patient subgroups. Conclusion This MA of chemotherapy in the supportive care setting demonstrates conclusively that chemotherapy improves overall survival in all patients with advanced NSCLC. Therefore, all patients who are fit enough and wish to receive chemotherapy should do so.
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Most individual trials and meta-analyses evaluating first-line chemotherapy options in advanced NSCLC did not report differential efficacy in patients with squamous cell carcinoma.
“Most individual trials and metaanalyses evaluating chemotherapy options in the first-line treatment of advanced NSCLC did not report any differential efficacy in patients with SCC [43].”
From Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up (2016) · cites this paper as [43]
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- Authors
- NSCLC Meta-Analyses Collaborative Group
- Corresponding author
- NSCLC Meta-Analyses Collaborative Group
- Venue
- Journal of Clinical Oncology
- Published
- 2008-10-01
- Volume
- 26
- Issue
- 28
- Pages
- 4617-4625
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC2653127
- OpenAlex
- W2626223149
- Cited by
- 604
- References
- 40
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 11 · 2023: 23 · 2022: 25 · 2021: 26 · 2020: 24 · 2019: 31 · 2018: 35 · 2017: 37 · 2016: 38 · 2015: 59 · 2014: 52 · 2013: 59 · 2012: 51
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Institut Gustave-Roussy
- Medical Research Council
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Health Sciences › Medicine › Oncology › Lung Cancer Research Studies
- Keywords
- non-small cell lung cancer, chemotherapy, supportive care, overall survival, advanced lung cancer, chemotherapy regimens, subgroup analysis
- MeSH terms
- Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Palliative Care, Survival Analysis, Randomized Controlled Trials as Topic
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