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Clinical option of pemetrexed-based versus paclitaxel-based first-line chemotherapeutic regimens in combination with bevacizumab for advanced non-squamous non-small-cell lung cancer and optimal maintenance therapy: evidence from a meta-analysis of randomized control trials
- Source :
- BMC Cancer, Vol 21, Iss 1, Pp 1-11 (2021), BMC Cancer
- Publication Year :
- 2021
- Publisher :
- BMC, 2021.
-
Abstract
- Background In the era of immunotherapy, it is still unclear which is the best first-line therapy for patients with oncogenic driver negative advanced non-squamous non-small cell lung cancer (NS-NSCLC) who cannot tolerate immunotherapy, or subsequent therapy for patients with oncogenic driver positive NS-NSCLC whose disease progressed on prior targeted therapy. To assess the optimal choice of first-line and maintenance treatment regimens, we performed a meta-analysis of prospective randomized controlled clinical trials (RCTs) of patients with NS-NSCLC on bevacizumab combined with chemotherapy. Methods All eligible RCTs comparing pemetrexed-platinum with or without bevacizumab (PP ± B) and paclitaxel-carboplatin with bevacizumab (PC + B) as a first-line therapy, or comparing bevacizumab plus pemetrexed (Pem + B) and bevacizumab alone (B) as a maintenance treatment for advanced NS-NSCLC, were included after systematically searching web databases and meeting abstracts. The main research endpoints were comparisons of overall survival (OS) and progression-free survival (PFS). The other endpoints were objective response rate (ORR), 1-year PFS rate (PFSR1y) and major grade 3/4 treatment-related adverse events. Results Data of 3139 patients from six RCTs were incorporated into analyses. Three RCTs were included in an analysis that compared PP ± B and PC + B as a first-line therapy for advanced NS-NSCLC. Patients treated with first-line PP ± B showed similar OS and ORR, but significantly improved PFS (hazard ratio [HR], 0.88) and PFSR1y (risk ratio [RR], 0.83), as compared to patients treated with PC + B (all P P P Conclusion Although the first-line PP + B regimen had longer PFS and PFSR1y than the PC + B regimen, no OS difference was observed. Addition of pemetrexed to bevacizumab as maintenance therapy significantly improved OS compared with bevacizumab maintenance alone, but led to more toxicity.
- Subjects :
- Oncology
Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Bevacizumab
Paclitaxel
medicine.medical_treatment
First-line treatment
Pemetrexed
Neutropenia
Maintenance Chemotherapy
03 medical and health sciences
0302 clinical medicine
Maintenance therapy
Internal medicine
Carcinoma, Non-Small-Cell Lung
Antineoplastic Combined Chemotherapy Protocols
Genetics
medicine
Humans
030212 general & internal medicine
Neoplasm Metastasis
RC254-282
Neoplasm Staging
Randomized Controlled Trials as Topic
Chemotherapy
Maintenance treatment
business.industry
Hazard ratio
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Induction Chemotherapy
medicine.disease
Regimen
Meta-analysis
Treatment Outcome
030220 oncology & carcinogenesis
Female
business
Publication Bias
Non-small-cell lung cancer
Febrile neutropenia
medicine.drug
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 14712407
- Volume :
- 21
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Cancer
- Accession number :
- edsair.doi.dedup.....a06d30056b14d44e50557bd92c24e314