Meta-analysis of randomized clinical trials comparing cisplatin to carboplatin in patients with advanced non-small-cell lung cancer
Meta-analysis of randomized clinical trials comparing cisplatin to carboplatin in patients with advanced non-small-cell lung cancer
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DOI：
10.1200/jco.2004.02.109
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发表时间：
2004-10-01
影响因子：
45.3
通讯作者：
Tanimoto, M
中科院分区：
文献类型：
--
作者：
Hotta, K;Matsuo, K;Tanimoto, M
目的 顺铂和卡铂对于晚期非小细胞肺癌 (NSCLC) 是否同样有效尚待确定。因此，我们对比较基于顺铂的化疗与基于卡铂的化疗的试验进行了荟萃分析。方法我们进行了文献检索，以确定研究卡铂替代顺铂治疗晚期 NSCLC 的试验。我们评估了这些试验的纳入情况，评价了方法学质量，并提取了相关数据。结果 在 1,191 份报告中，确定了 8 项试验（2,948 名患者），其中 5 项研究了含有铂加新药的药物治疗方案。基于顺铂的化疗产生了较高的缓解率，但生存优势并不显着（风险比 = 1.050；95% Cl，0.907 至 1.216；P = .515）。亚组分析显示，由顺铂加一种新药组成的联合化疗比卡铂加相同新药的生存期延长 11%（风险比 = 1.106；95% Cl，1.005 至 1.218；P = 0.039）。接受以顺铂为基础的化疗的患者经常出现恶心和呕吐；而在以卡铂为基础的化疗期间，血小板减少症更常见。治疗相关死亡率没有观察到显着差异。 结论 我们发现，在晚期 NSCLC 患者中，由顺铂加新药组成的联合化疗比卡铂加新药具有显着的生存优势，尽管我们在包括新药和旧药的分析中未能发现任何生存差异。我们的结论的力度有限，因为我们使用了抽象数据，因此需要仔细解释。尽管如此，我们的结果提出了一个需要在未来研究中评估的关键点。 (C) 2004 年，美国临床肿瘤学会。
Purpose It remains undetermined whether cisplatin and carboplatin are equally effective for advanced non-small-cell lung cancer (NSCLC). We therefore did a meta-analysis of trials that compared cisplatin-based chemotherapy with carboplatin-based chemotherapy.Methods We performed a literature search to identify trials that had investigated the substitution of carboplatin for cisplatin in the treatment of advanced NSCLC. We evaluated these trials for inclusion, rated methodologic quality, and abstracted relevant data.Results Of 1,191 reports, eight trials (2,948 patients) were identified, five of which investigated drug regimens containing platinum plus a new agent. Cisplatin-based chemotherapy produced a higher response rate, but the survival advantage was not significant (hazard ratio = 1.050; 95% Cl, 0.907 to 1.216; P = .515). Subgroup analysis revealed that combination chemotherapy consisting of cisplatin plus a new agent yields 11% longer survival than carboplatin plus the same new agent (hazard ratio = 1.106; 95% Cl, 1.005 to 1.218; P = .039). Patients on cisplatin-based chemotherapy frequently developed nausea and vomiting;, thrombocytopenia was more frequent during carboplatin-based chemotherapy. No significant difference in treatment-related mortality was observed.Conclusion We found that combination chemotherapy consisting of cisplatin plus a new agent yields a substantial survival advantage compared with carboplatin plus a new agent in patients with advanced NSCLC, although we failed to find any survival difference in an analysis that included both new and old agents. The strength of our conclusion is limited because we used abstracted data, and careful interpretation is thus required. Nevertheless, our results raise a critical point that needs to be evaluated in future studies. (C) 2004 by American Society of Clinical Oncology.