CHEMOTHERAPY IN NON-SMALL-CELL LUNG-CANCER - A METAANALYSIS USING UPDATED DATA ON INDIVIDUAL PATIENTS FROM 52 RANDOMIZED CLINICAL-TRIALS

Objective-To evaluate the effect of cytotoxic chemotherapy on survival in patients with non-small cell lung cancer. Design-Meta-analysis usi ng updated data on individual patients from all available randomised t rials, both published and unpublished. Subjects-9387 patients (7151 de aths) from 52 randomised clinical trials. Main outcome measure-Surviva l. Results-The results for modern regimens containing cisplatin favour ed chemotherapy in all comparisons and reached conventional levels of significance when used with radical radiotherapy and with supportive c are. Trials comparing surgery with surgery plus chemotherapy gave a ha zard ratio of 0.87 (13% reduction in the risk of death, equivalent to an absolute benefit of 5% at five years). Trials comparing radical rad iotherapy with radical radiotherapy plus chemotherapy gave a hazard ra tio of 0.87 (13% reduction in the risk of death; absolute benefit of 4 % at two years), and trials comparing supportive care with supportive care plus chemotherapy 0.73 (27% reduction in the risk of death; 10% i mprovement in survival at one year). The essential drugs needed to ach ieve these effects were not identified. No difference in the size of e ffect was seen in any subgroup of patients. In all but the radical rad iotherapy setting, older trials using long term alkylating agents tend ed to show a detrimental effect of chemotherapy. This effect reached c onventional significance in the adjuvant surgical comparison. Conclusi on-At the outset of this meta-analysis there was considerable pessimis m about the role of chemotherapy in non-small cell lung cancer. These results offer hope of progress and suggest that chemotherapy may have a role in treating this disease.