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Chemotherapy plus multitargeted antiangiogenic tyrosine kinase inhibitors or chemotherapy alone in advanced NSCLC: a meta-analysis of randomized controlled trials

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Abstract

Background

Most patients with advanced non-small-cell lung cancer (NSCLC) require systemic chemotherapy. Chemotherapy plus multitargeted antiangiogenic tyrosine kinase inhibitors (TKI; e.g., sorafenib, sunitinib, cediranib, vandetanib, BIBF 1120, pazopanib, axitinib) has recently been evaluated in patients with NSCLC. However, the advantage of this therapy over chemotherapy alone in patients with advanced NSCLC remains largely unknown.

Methods

A meta-analysis of randomized controlled trials (RCTs) was performed to compare the efficacy and toxicity of chemotherapy plus multitargeted antiangiogenic TKI with chemotherapy alone in patients with advanced NSCLC. PubMed, the ASCO and ESMO databases, and the Cochrane Library were searched for references to published articles. Two reviewers independently assessed the quality of the trials. Data were extracted, and overall response rate (ORR), pooled progression-free survival (PFS), overall survival (OS) with 95 % confidence intervals (CI), and major toxicities/adverse effects were analyzed.

Results

Six RCTs involving 3,337 patients with advanced NSCLC were ultimately analyzed. Compared to chemotherapy alone, chemotherapy plus multitargeted antiangiogenic TKI significantly increased the ORR [relative risk (RR) 1.71, 95 % CI  1.43–2.05] and PFS [hazard ratio (HR)  0.83, 95 % CI 0.76–0.90], but not OS (HR 0.93, 95 % CI 0.83–1.03). Patients who received chemotherapy plus multitargeted antiangiogenic TKI exhibited more rash, diarrhea and hypertension (OR 2.78, 95 % CI  2.37–3.26; OR 1.92, 95 % CI 1.65–2.24; OR  2.90, 95 % CI 2.19–3.84, respectively) and less nausea and vomiting (OR 0.71, 95 % CI 0.60–0.83; OR 0.75, 95 % CI 0.61–0.92, respectively). The incidence of hemorrhage, fatigue, cough, constipation, anorexia, and alopecia were comparable between the two groups.

Conclusions

Therapy consisting of chemotherapy plus multitargeted antiangiogenic TKI was found to have specific advantages over chemotherapy alone in terms of PFS and ORR. The toxicity was comparable between the two therapies. Therefore, chemotherapy plus multitargeted antiangiogenic TKI may be a safe and valid therapeutic option for patients with advanced NSCLC.

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The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Respiratory and Critical care Medicine, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, China

    Yong-Ying Xiao, Dong-Mei Yuan, Hong-Bing Liu, Tang-Feng Lv, Yong Song & Yi Shi

  2. First Department of Respiratory Medicine, Nanjing Chest Hospital, Nanjing, China

    Ping Zhan

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  1. Yong-Ying Xiao
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  2. Ping Zhan
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  3. Dong-Mei Yuan
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  4. Hong-Bing Liu
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  6. Yong Song
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  7. Yi Shi
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Correspondence to Yong Song or Yi Shi.

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Xiao, YY., Zhan, P., Yuan, DM. et al. Chemotherapy plus multitargeted antiangiogenic tyrosine kinase inhibitors or chemotherapy alone in advanced NSCLC: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 69, 151–159 (2013). https://doi.org/10.1007/s00228-012-1333-3

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  • DOI: https://doi.org/10.1007/s00228-012-1333-3

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