Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC)

A meta-analysis of individual data from 1764 patients

A. Aupérin, C. Le Péchoux, J. P. Pignon, C. Koning, B. Jeremic, G. Clamon, Lawrence Einhorn, D. Ball, M. G. Trovo, H. J M Groen, J. A. Bonner, T. Le Chevalier, R. Arriagada

Research output: Contribution to journalArticle

200 Citations (Scopus)

Abstract

Background: Despite several randomised trials comparing radiotherapy alone with concomitant radio-chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC), it is not clear whether the addition of chemotherapy improves survival. Patients and methods: This meta-analysis was based on individual patient data from published and unpublished randomised trials which compared radiotherapy alone with the same radiotherapy combined with concomitant cisplatin- or carboplatin-based chemotherapy. Trials with accrual completed after 2000 were excluded. Trials were sought in electronic databases, clinical trial registries and by additional manual searches. The primary endpoint was overall survival analysed using the log-rank test stratified by trials. Results: There were twelve eligible trials that included a total of 1921 patients. The data from 3 trials were not available. Therefore, the analysis was based on 9 trials including 1764 patients. Median follow-up was 7.2 years. The hazard ratio of death among patients treated with radio-chemotherapy compared to radiotherapy alone was 0.89 (95% confidence interval, 0.81-0.98; P = 0.02) corresponding to an absolute benefit of chemotherapy of 4% at 2 years. There was some evidence of heterogeneity among trials and sensitivity analyses did not lead to consistent results. The combination of platin with etoposide seemed more effective than platin alone. Conclusions: Concomitant platin-based radio-chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.

Original languageEnglish
Pages (from-to)473-483
Number of pages11
JournalAnnals of Oncology
Volume17
Issue number3
DOIs
StatePublished - Mar 2006

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Radio
Non-Small Cell Lung Carcinoma
Meta-Analysis
Drug Therapy
Radiotherapy
Survival
Carboplatin
Etoposide
Cisplatin
Registries
Appointments and Schedules
Clinical Trials
Databases
Confidence Intervals

Keywords

  • Concomitant radio-chemotherapy
  • Individual patient data
  • Locally advanced non-small cell lung cancer
  • Meta-analysis
  • Randomised trial
  • Systematic review

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC) : A meta-analysis of individual data from 1764 patients. / Aupérin, A.; Le Péchoux, C.; Pignon, J. P.; Koning, C.; Jeremic, B.; Clamon, G.; Einhorn, Lawrence; Ball, D.; Trovo, M. G.; Groen, H. J M; Bonner, J. A.; Le Chevalier, T.; Arriagada, R.

In: Annals of Oncology, Vol. 17, No. 3, 03.2006, p. 473-483.

Research output: Contribution to journalArticle

Aupérin, A, Le Péchoux, C, Pignon, JP, Koning, C, Jeremic, B, Clamon, G, Einhorn, L, Ball, D, Trovo, MG, Groen, HJM, Bonner, JA, Le Chevalier, T & Arriagada, R 2006, 'Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): A meta-analysis of individual data from 1764 patients', Annals of Oncology, vol. 17, no. 3, pp. 473-483. https://doi.org/10.1093/annonc/mdj117
Aupérin, A. ; Le Péchoux, C. ; Pignon, J. P. ; Koning, C. ; Jeremic, B. ; Clamon, G. ; Einhorn, Lawrence ; Ball, D. ; Trovo, M. G. ; Groen, H. J M ; Bonner, J. A. ; Le Chevalier, T. ; Arriagada, R. / Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC) : A meta-analysis of individual data from 1764 patients. In: Annals of Oncology. 2006 ; Vol. 17, No. 3. pp. 473-483.
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abstract = "Background: Despite several randomised trials comparing radiotherapy alone with concomitant radio-chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC), it is not clear whether the addition of chemotherapy improves survival. Patients and methods: This meta-analysis was based on individual patient data from published and unpublished randomised trials which compared radiotherapy alone with the same radiotherapy combined with concomitant cisplatin- or carboplatin-based chemotherapy. Trials with accrual completed after 2000 were excluded. Trials were sought in electronic databases, clinical trial registries and by additional manual searches. The primary endpoint was overall survival analysed using the log-rank test stratified by trials. Results: There were twelve eligible trials that included a total of 1921 patients. The data from 3 trials were not available. Therefore, the analysis was based on 9 trials including 1764 patients. Median follow-up was 7.2 years. The hazard ratio of death among patients treated with radio-chemotherapy compared to radiotherapy alone was 0.89 (95{\%} confidence interval, 0.81-0.98; P = 0.02) corresponding to an absolute benefit of chemotherapy of 4{\%} at 2 years. There was some evidence of heterogeneity among trials and sensitivity analyses did not lead to consistent results. The combination of platin with etoposide seemed more effective than platin alone. Conclusions: Concomitant platin-based radio-chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.",
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AU - Le Péchoux, C.

AU - Pignon, J. P.

AU - Koning, C.

AU - Jeremic, B.

AU - Clamon, G.

AU - Einhorn, Lawrence

AU - Ball, D.

AU - Trovo, M. G.

AU - Groen, H. J M

AU - Bonner, J. A.

AU - Le Chevalier, T.

AU - Arriagada, R.

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N2 - Background: Despite several randomised trials comparing radiotherapy alone with concomitant radio-chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC), it is not clear whether the addition of chemotherapy improves survival. Patients and methods: This meta-analysis was based on individual patient data from published and unpublished randomised trials which compared radiotherapy alone with the same radiotherapy combined with concomitant cisplatin- or carboplatin-based chemotherapy. Trials with accrual completed after 2000 were excluded. Trials were sought in electronic databases, clinical trial registries and by additional manual searches. The primary endpoint was overall survival analysed using the log-rank test stratified by trials. Results: There were twelve eligible trials that included a total of 1921 patients. The data from 3 trials were not available. Therefore, the analysis was based on 9 trials including 1764 patients. Median follow-up was 7.2 years. The hazard ratio of death among patients treated with radio-chemotherapy compared to radiotherapy alone was 0.89 (95% confidence interval, 0.81-0.98; P = 0.02) corresponding to an absolute benefit of chemotherapy of 4% at 2 years. There was some evidence of heterogeneity among trials and sensitivity analyses did not lead to consistent results. The combination of platin with etoposide seemed more effective than platin alone. Conclusions: Concomitant platin-based radio-chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.

AB - Background: Despite several randomised trials comparing radiotherapy alone with concomitant radio-chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC), it is not clear whether the addition of chemotherapy improves survival. Patients and methods: This meta-analysis was based on individual patient data from published and unpublished randomised trials which compared radiotherapy alone with the same radiotherapy combined with concomitant cisplatin- or carboplatin-based chemotherapy. Trials with accrual completed after 2000 were excluded. Trials were sought in electronic databases, clinical trial registries and by additional manual searches. The primary endpoint was overall survival analysed using the log-rank test stratified by trials. Results: There were twelve eligible trials that included a total of 1921 patients. The data from 3 trials were not available. Therefore, the analysis was based on 9 trials including 1764 patients. Median follow-up was 7.2 years. The hazard ratio of death among patients treated with radio-chemotherapy compared to radiotherapy alone was 0.89 (95% confidence interval, 0.81-0.98; P = 0.02) corresponding to an absolute benefit of chemotherapy of 4% at 2 years. There was some evidence of heterogeneity among trials and sensitivity analyses did not lead to consistent results. The combination of platin with etoposide seemed more effective than platin alone. Conclusions: Concomitant platin-based radio-chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.

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