1
|
Zhang Y, Hu X, Liu D, Wang R, Sun X, Peng Z, Ren H, Du N. Effectiveness of neoadjuvant chemotherapy on the survival outcomes of patients with resectable non-small-cell lung cancer: A meta-analysis of randomized controlled trials. Surg Oncol 2021; 38:101590. [PMID: 34091269 DOI: 10.1016/j.suronc.2021.101590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the effectiveness of neoadjuvant chemotherapy (NACT) versus primary surgery on survival outcomes for resectable non-small-cell lung cancer (NSCLC) using an approach based on a meta-analysis. METHODS The PubMed, EmBase, Cochrane library, and CNKI databases were systematically browsed to identify randomized controlled trials (RCTs) which met a set of predetermined inclusion criteria throughout January 2020. Hazard ratios (HRs) were applied for the pooled overall survival (OS) and progression-free survival (PFS) values, and the pooled survival rates at 1-year and 3-year were used as the relative risk (RR). All the pooled effect estimates with 95% confidence intervals (CIs) were calculated using the random-effects model. RESULTS Nineteen RCTs contained a total of 4372 NSCLC at I-III stages was selected for final meta-analysis. We noted NACT was significantly associated with an improvement in OS (HR: 0.87; 95%CI: 0.81-0.94; P < 0.001) and PFS (HR: 0.86; 95%CI: 0.78-0.96; P = 0.005). Moreover, the survival rate at 1-year (RR: 1.07; 95%CI: 1.02-1.12; P = 0.007) and 3-year (RR: 1.16; 95%CI: 1.06-1.27; P = 0.001) in the NACT group was significantly higher than the survival rate for the primary surgery group. Finally, the treatment effects of NACT versus primary surgery on survival outcomes might be different when stratified by the mean age of patients and the tumor stages. CONCLUSIONS NACT could improve survival outcomes for patients with resectable NSCLC, suggesting its suitable future applicability for clinical practice. However, large-scale RCT should be conducted to assess the chemotherapy regimen on the prognosis of resectable NSCLC.
Collapse
Affiliation(s)
- Yunfeng Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Xiayun Hu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Dapeng Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Rui Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Xin Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Ziyang Peng
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Hong Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China
| | - Ning Du
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, PR China.
| |
Collapse
|
2
|
Romine PE, Martins RG, Eaton KD, Wood DE, Behnia F, Goulart BHL, Mulligan MS, Wallace SG, Kell E, Bauman JE, Patel SA, Vesselle HJ. Long term follow-up of neoadjuvant chemotherapy for non-small cell lung cancer (NSCLC) investigating early positron emission tomography (PET) scan as a predictor of outcome. BMC Cancer 2019; 19:70. [PMID: 30642285 PMCID: PMC6332837 DOI: 10.1186/s12885-019-5284-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background Neoadjuvant chemotherapy is effective in improving survival of resectable NSCLC. Based on findings in the adjuvant and metastatic setting, FDG positron emission tomography (PET) scans may offer early prognostic or predictive value after one cycle of induction chemotherapy. Methods In this phase II non-randomized trial, patients with AJCC version 6 stage IB to IIIB operable NSCLC were treated with 3 cycles of cisplatin and pemetrexed neoadjuvant chemotherapy. Patients underwent FDG-PET scanning prior to and 18 to 21 days after the first cycle of chemotherapy. Investigators caring for patients were blinded to results, unless the scans showed evidence of disease progression. FDG-PET response was defined prospectively as a ≥ 20% decrease in the SUV of the primary lesion. Results Between October 2005 and February 2010, 25 patients enrolled. Fifty two percent were female, 88% white, and median age was 62 years. Histology was divided into adenocarcinoma 66%, not otherwise specified (NOS) 16%, squamous cell 12%, and large cell 4%. Stage distribution was: 16% IB, 4% IIB, and 79% IIIA. Treatment was well tolerated and only one patient had a grade 4 toxicity. The median follow up was 95 months. The 5 year progression free survival (PFS) and overall survival (OS) for the entire population were 54 and 67%, respectively. Eighteen patients had a baseline FDG-PET scan and a repeat scan at day 18–21 available for comparison. Ten patients (56%) were considered metabolic responders on the day 18–21 FDG-PET scan. Responders had a 5 year PFS and OS of 60 and 70%, respectively, while the percentage for non-responders was 63 and 75% (p = 0.96 and 0.85). Conclusions This phase II trial did not demonstrate that a PET scan after one cycle of chemotherapy can predict survival outcomes of patients with NSCLC treated with neoadjuvant chemotherapy. Trial registration NCT00227539 registered September 28th, 2005.
Collapse
Affiliation(s)
- Perrin E Romine
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Renato G Martins
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Keith D Eaton
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA. .,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA.
| | - Douglas E Wood
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Fatemeh Behnia
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Bernardo H L Goulart
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Michael S Mulligan
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Sarah G Wallace
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Elizabeth Kell
- Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | | | | | - Hubert J Vesselle
- University of Washington, School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| |
Collapse
|
3
|
Hilbe W, Pall G, Kocher F, Pircher A, Zabernigg A, Schmid T, Schumacher M, Jamnig H, Fiegl M, Gächter A, Freund M, Kendler D, Manzl C, Zelger B, Popper H, Wöll E. Multicenter Phase II Study Evaluating Two Cycles of Docetaxel, Cisplatin and Cetuximab as Induction Regimen Prior to Surgery in Chemotherapy-Naive Patients with NSCLC Stage IB-IIIA (INN06-Study). PLoS One 2015; 10:e0125364. [PMID: 26020783 PMCID: PMC4447267 DOI: 10.1371/journal.pone.0125364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Different strategies for neoadjuvant chemotherapy in patients with early stage NSCLC have already been evaluated. The aim of this study was to evaluate the tolerability and efficacy of a chemoimmunotherapy when limited to two cycles. Methods Between 01/2007 and 03/2010 41 patients with primarily resectable NSCLC stage IB to IIIA were included. Treatment consisted of two cycles cisplatin (40 mg/m2 d1+2) and docetaxel (75 mg/m2 d1) q3 weeks, accompanied by the administration of cetuximab (400 mg/m2 d1, then 250 mg weekly). The primary endpoint was radiological response according to RECIST. Results 40 patients were evaluable for toxicity, 39 for response. The main grade 3/4 toxicities were: neutropenia 25%, leucopenia 11%, febrile neutropenia 6%, nausea 8% and rash 8%. 20 patients achieved a partial response, 17 a stable disease, 2 were not evaluable. 37 patients (95%) underwent surgery and in three of them a complete pathological response was achieved. At a median follow-up of 44.2 months, 41% of the patients had died, median progression-free survival was 22.5 months. Conclusions Two cycles of cisplatin/ docetaxel/ cetuximab showed promising efficacy in the neoadjuvant treatment of early-stage NSCLC and rapid operation was possible in 95% of patients. Toxicities were manageable and as expected. Trial Registration EU Clinical Trials Register; Eudract-Nr: 2006-004639-31
Collapse
Affiliation(s)
- Wolfgang Hilbe
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
- * E-mail:
| | - Georg Pall
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Florian Kocher
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
- Tyrolean Cancer Research Institute, Innsbruck, Austria
| | - Andreas Pircher
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - August Zabernigg
- Department of Internal Medicine, County Hospital Kufstein, Kufstein, Austria
| | - Thomas Schmid
- Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Schumacher
- Department of Pneumology, General Hospital, Elisabethinen Linz, Linz, Austria
| | - Herbert Jamnig
- Department of Pneumology, County Hospital Natters, Natters, Austria
| | - Michael Fiegl
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Anne Gächter
- Medical University Innsbruck, Department of Internal Medicine V (Haematology and Oncology), Innsbruck, Austria
| | - Martin Freund
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Dorota Kendler
- Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Claudia Manzl
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Bettina Zelger
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Helmut Popper
- Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
- Department of Pathology, Medical University Graz, Graz, Austria
| | - Ewald Wöll
- Department of Internal Medicine, Saint Vincent Hospital Zams, Zams, Austria
| |
Collapse
|