Objective To evaluate the effectiveness and safety of nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced non-small cell lung cancer (NSCLC). Methods The randomized controlled trials (RCTs) on nedaplatin combined with chemotherapy versus cisplatin combined with chemotherapy for advanced NSCLC were searched in The Cochrane Library, PubMed, EMbase, CBM, VIP and WanFang Data from the date of their establishment to January 2012. According to the inclusion and exclusion criteria, two reviewers independently screened the studies, extracted the data and assessed the quality. Then RevMan 5.0 software was used for meta-analysis. Results A total of 15 RCTs involving 1 076 patients were included. The results of meta-analysis showed that, compared with the cisplatin combined with chemotherapy, nedaplatin combined with chemotherapy could reduce the risks of nausea and vomiting (RR=0.56, 95%CI 0.48 to 0.65, Plt;0.000 01), decrease the risk of renal function impairment (RR=0.47, 95%CI 0.30 to 0.74, P=0.001), but increase the risk of thrombocytopenia (RR=1.59, 95%CI 1.20 to 2.11, P=0.001). There were no significant differences between the two groups in objective response rate (ORR) (RR=1.09, 95%CI 0.92 to 1.29, P=0.03), leukopenia (RR=1.05, 95%CI 0.92 to 1.19, P=0.50), and hemoglobin reduction (RR=0.92, 95%CI 0.80 to 1.07, P=0.30). Conclusion Compared with cisplatin combined with chemotherapy for advanced NSCLC patients, nedaplatin in combination with chemotherapy can significantly reduce the risks of nausea, vomiting and renal function impairment. Although the ORRs are similar in the two groups, nedaplatin combined with chemotherapy can cause a higher risk of thrombocytopenia. For the quality restriction and possible publication bias of the included studies, more high quality RCTs are required to further verify this conclusion.
The resistance of non-small cell lung cancer (NSCLC) to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has been brought into focus. COX-2 signal pathway was found to be closely related to EGFR signal pathway by recent researches, and there has been a growing interest to focus the researches on whether COX-2 pathway inhibition improves the efficacy of EGFR-TKIs in treating advanced NSCLC. In this review, we will illustrate recent advances of combined inhibition of EGFR and COX-2 signal pathways in NSCLC therapy.
Objective To systematically review the effectiveness and safety of erlotinib for the elderly with Non-small-cell lung cancer (NSCLC). Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were electronically searched for relevant randomized controlled trails (RCTs). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally 5 studies were included. The results of meta-analysis showed that, the objective response rate and stable disease rate was similar between the erlotinib group and the control group with no significant difference (RR=0.99, 95%CI 0.34 to 2.93, P=0.99; RR=1.17, 95%CI 0.95 to 1.43, P=0.14). The incidences of Grade Ⅲ-Ⅳ neutropenia and thrombocytopenia were lower in the erlotinib group than those in the control group (OR=0.12, 95%CI 0.03 to 0.52, P=0.005; OR=0.19, 95%CI 0.04 to 0.91, P=0.04); and the incidences of nausea and vomiting as wel as liver impairments were alike between the two groups (OR=0.93, 95%CI 0.12 to 7.08, P=0.95; OR=0.80, 95%CI 0.24 to 2.68, P=0.71); the incidences of diarrhea and skin rashes in the erlotinib group were higher (OR=5.96, 95%CI 1.28 to 27.88, P=0.02; OR=6.77, 95%CI 1.52 to 30.10, P=0.01). Conclusion Current evidence shows that, erlotinib is effective and safe in treating the elderly with NSCLC with better effects and no serious adverse reaction. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
Objective To assess the effectiveness and safety of high-dose chemotherapy assisted with autologous peripheral blood stem cell treatment (APBSCT+HDC) for small cell lung cancer (SCLC). Methods The databases such as MEDLINE (1970 to January 2011), EMBASE (1980 to January 2011), Science Direct (1980 to January 2011), The Cochrane Library (Issue 3, 2010), CNKI (from the date of establishment to December 2010), CBM (from the date of establishment to December 2010) and Wanfang database (from the date of establishment to December 2010) were searched for collecting randomized controlled trials (RCTs) on APBSCT+HDC for SCLC. According to the inclusive and exclusive criteria, the trials were screened, the data were extracted, the methodological quality was assessed, and then Meta-analysis was conducted by using RevMan 5.0 software. Results A total of 6 RCTs involving 737 patients with SCLC were included. The results of Meta-analyses were as follows: the APBSCT+HDC for SCLC was significantly superior to the conventional chemotherapy in the total effective rate (RR=1.14, 95%CI 1.07 to 1.21, Plt;0.000 1) and the overall survival rate (RR=3.74, 95%CI 2.13 to 6.58, Plt;0.000 01), and it was superior in reducing the incidence of III/IV grade red blood cell reduction (RR=1.97, 95%CI 1.15 to 3.38, P=0.01) and thrombopenia (RR=1.93, 95%CI 1.06 to 3.54, P=0.03) with significant differences; but there was no significant difference between the two groups in reducing the incidence of III/IV leukopenia. Conclusions Compared with the conventional chemotherapy, APBSCT+HDC treatment for SCLC can improve the overall effective rate and overall survival rate, but it can also increase the risks of severe hematologic toxic reaction. Because of the small scale and low quality of the included studies, this conclusion still needs to be confirmed by high-quality, large-scale and multi-centered RCTs.
Objective To make an individulized treatment plan for a patient with locally advanced non-small cell lung cancer (NSCLC). Methods After clinical problems were put forward, evidence was collected from http://www. nccn.org. The Cochrane Library (Issue 4, 2008), Medline (PubMed 1990. 1-2008.11) and CHKD periodical database were searched. Results A total of 21 RCTs, 5 systematic reviews and 13 CT phase Ⅲ trials were identified. A rational treatment plan was made upon a serious evaluation of the data. After nine monthes of follow-up, the plan was proved optimal. Conclusion For locally advanced NSCLC patients, an individulized treatment plan made by evidence-based methods not only can inprove the treatment efficacy but also can lead both of doctors and patients to assume the indeterminateness of medicine.
Lung cancer is an epithelial cancer arising from the bronchial surface epithelium or bronchial mucous glands. Non-small lung cancer constitutes about 75%-80% of all lung cancer. At the time of diagnosis, a lot of people have got stage Ⅲb non-small lung cancer which is unresectalbe. Both chemotherapy and radiotherapy are widely used in unresectable stage Ⅲ non-small lung cancer. The regimes of chemotherapy or radiotherapy are varied too. Systematic reviews and randomized controlled trials have provide much convincing evidence for us to choose and utilize the most appropriate treatment.
Objective To assess the effectiveness of adjuvant chemotherapy with complete resection for non-small cell lung cancer. Methods We searched MEDLINE （1966 ～ 2005 ）, EMBASE （1984-2005 ）, The Cochrane Library （Issue 2,2005 ）, CBMdisc （1979-2005 ）, CNKI （1994-2005 ）, VIP （1989-2005 ）, CMCC （1994-2005 ） and Wanfang Database with key words of non-small cell lung cancer or NSCLC and adjuvant chemotherapy, to identify randomized control trials （RCTs） of platinum-based adjuvant chemotherapy plus complete resection versus complete resection alone for non-small cell lung cancer patients. Two reviewers evaluated the quality of literature independently. Then we conducted meta-analysis using RevMan 4.2.7 software. Results We identified 9 RCTs and did not carry out pool analysis for the difference of chemotherapy regimens between the studies. The results of three studies showed that 5 years＇ mortality of adjuvant chemotherapy group was lower than that of surgery group alone. The results of the other 6 studies showed there was no statistical difference in 5 years＇ mortality between the adjuvant chemotherapy plus surgery and surgery alone groups. Conclusions The effectiveness of some adjuvant chemotherapy regimens with complete resection in patients with non-small cell lung cancer has been improved. But the number of each chemotherapy regimen RCT is too small and with poor quality. So more multi-center RCTs with a larger sample size and high quality are needed.
Objective To report evidence-based treatment for 2 case of Ⅱ B stage non-small cell lung cancer. Methods We searched systematic reviews and randomized controlled trials in The Cochrane Library (Issue 2, 2009), MEDLINE (PubMed, January 1970 to June 2009) and ACP Journal Club (1996 to June 2009), and evaluated the evidence. Results The best clinical evidence for Ⅰ and Ⅱ stage non-small cell lung cancer patients showed that in the patients with resectable nonsmall cell lung cancer, postoperative adjuvant radiotherapy and chemotherapy could not improve survival compared with surgery alone. We did not find evidence which indicated that preoperative chemotherapy improved survival in people with resectable non-small cell lung cancer. Conclusion In accordance with the wishes of the patient and family, they do not accept the radiotherapy and chemotherapy, but choose palliative and supportive therapy.
Objective To evaluate the prognostic value of the level of serum neurone specific enolase (NSE) in patients with small cell lung cancer (SCLC). Methods We searched MEDLINE, EMbase, CBMdisc, and The Cochrane Central Register of Controlled Trials (1950 to December 2007). Studies meeting the eligibility criteria were retrieved and their bibliographies were checked for other relevant publications. The quality of included studies was evaluated by 2 reviewers independently. Meta-analyses were performed for the results of homogeneous studies using STATA 7.0 software. Results Nine studies involving 2 021 SCLC patients were included. About 66.0% of patients had high serum levels of NSE, according to the cut-off value defined by the authors. The hazard ratio (HR) of high levels of NSE for overall survival (OS) was 1.27 times of that of low levels of NSE for OS in SCLC patients (95% CI 1.19 to 1.35, P=0.281). Conclusion Patients with high levels of NSE appear to have a poorer OS compared with those with low levels of NSE, thus the level of NSE has a prognostic value in SCLC patients. Due to the potential publication bias, selection bias, and measurement bias among these studies, the conclusion should be interpreted carefully. More high-quality homogeneous studies are required to accurately evaluate the prognostic value of NSE.