Single-agent maintenance therapy for advanced non-small cell lung cancer (NSCLC): a systematic review and Bayesian network meta-analysis of 26 randomized controlled trials Qinxue Wang1 ,* , Haobin Huang2 ,* , Xiaoning Zeng1 , Yuan Ma1 , Xin Zhao1 and Mao Huang1 1
Department of Respiratory & Critical Care Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China 2 Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China * These authors contributed equally to this work.
ABSTRACT
Submitted 25 February 2016 Accepted 12 September 2016 Published 20 October 2016 Corresponding authors Xin Zhao, xinzhao1104@126.com Mao Huang, huangmao6114@126.com Academic editor Melania Pintilie Additional Information and Declarations can be found on page 17
Background. The benefit of maintenance therapy has been confirmed in patients with non-progressing non-small cell lung cancer (NSCLC) after first-line therapy by many trials and meta-analyses. However, since few head-to-head trials between different regimens have been reported, clinicians still have little guidance on how to select the most efficacious single-agent regimen. Hence, we present a network meta-analysis to assess the comparative treatment efficacy of several single-agent maintenance therapy regimens for stage III/IV NSCLC. Methods. A comprehensive literature search of public databases and conference proceedings was performed. Randomized clinical trials (RCTs) meeting the eligible criteria were integrated into a Bayesian network meta-analysis. The primary outcome was overall survival (OS) and the secondary outcome was progression free survival (PFS). Results. A total of 26 trials covering 7,839 patients were identified, of which 24 trials were included in the OS analysis, while 23 trials were included in the PFS analysis. Switch-racotumomab-alum vaccine and switch-pemetrexed were identified as the most efficacious regimens based on OS (HR, 0.64; 95% CrI, 0.45–0.92) and PFS (HR, 0.54; 95% CrI, 0.26–1.04) separately. According to the rank order based on OS, switch-racotumomab-alum vaccine had the highest probability as the most effective regimen (52%), while switch-pemetrexed ranked first (34%) based on PFS. Conclusions. Several single-agent maintenance therapy regimens can prolong OS and PFS for stage III/IV NSCLC. Switch-racotumomab-alum vaccine maintenance therapy may be the most optimal regimen, but should be confirmed by additional evidence.
DOI 10.7717/peerj.2550 Copyright 2016 Wang et al.
Subjects Evidence Based Medicine, Oncology, Respiratory Medicine Keywords Non-small cell lung cancer, Maintenance therapy, Bayesian network meta-analysis
Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS
How to cite this article Wang et al. (2016), Single-agent maintenance therapy for advanced non-small cell lung cancer (NSCLC): a systematic review and Bayesian network meta-analysis of 26 randomized controlled trials. PeerJ 4:e2550; DOI 10.7717/peerj.2550