Platinum versus non‐platinum chemotherapy regimens for small cell lung cancer

Isuru U Amarasena; Julia AE Walters; Richard Wood‐Baker; Kwun Fong

doi:10.1002/14651858.CD006849.pub2

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Figure 1

Survival by Subgroup

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Analysis 1.1

Comparison 1 Treatment Regimens, Outcome 1 6‐month survival.

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Analysis 1.2

Comparison 1 Treatment Regimens, Outcome 2 12‐month survival.

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Analysis 1.3

Comparison 1 Treatment Regimens, Outcome 3 24‐month survival.

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Analysis 1.4

Comparison 1 Treatment Regimens, Outcome 4 Overall response.

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Analysis 1.5

Comparison 1 Treatment Regimens, Outcome 5 Complete response.

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Analysis 1.6

Comparison 1 Treatment Regimens, Outcome 6 Toxic Death.

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Analysis 1.7

Comparison 1 Treatment Regimens, Outcome 7 Nausea and Vomiting.

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Analysis 1.8

Comparison 1 Treatment Regimens, Outcome 8 Alopecia.

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Analysis 1.9

Comparison 1 Treatment Regimens, Outcome 9 Infection.

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Analysis 1.10

Comparison 1 Treatment Regimens, Outcome 10 Anaemia.

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Analysis 1.11

Comparison 1 Treatment Regimens, Outcome 11 Leukopenia.

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Analysis 1.12

Comparison 1 Treatment Regimens, Outcome 12 Thrombocytopenia.

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Analysis 1.13

Comparison 1 Treatment Regimens, Outcome 13 Granulocytopenia.

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Table 1. Summary of included studies

Study ID		Number of Patients			Radiotherapy
First Author	Year	Platinum group	Non‐platinum group	Total
Chahinian	1989	105	103	208	PCI
Creech	1982	21	19	40	‐
Eagan	1981	31	31	62	TRT
Evans	1987	145	144	289	PCI, TRT
Farris	1993	56	57	113	PCI, TRT
Fukuoka	1986	35	34	69	TRT
Fukuoka	1991	97	97	194	TRT
Gatzemeier	1994	171	173	344	‐
Goodman	1990	194	194	388	PCI, TRT
Greco	2005	60	60	120	PCI
Havemann	1987	150	152	302	PCI, TRT
Jones	1993	54	50	104	PCI, TRT
Kanitz	1992	59	52	111	‐
Lyss	2002	12	13	25	PCI
Postmus	1992	60	63	123	PCI
Postmus	1996	70	73	143	‐
Quoix	2005	41	41	82	‐
Roth	1992	148	146	294	PCI
Sculier	1990	95	106	201	PCI
Sculier	1993	107	108	215	PCI, TRT
Smith	1991	47	48	95	PCI
Souhami	1997	80	75	155	‐
Sundstrom	2002	218	218	436	PCI, TRT
Urban	1999a	191	203	394	PCI, TRT
Urban	1999b	229	228	457	PCI, TRT
Veronesi	1994	70	66	136	PCI, TRT
Wampler	1991	85	85	170	‐
White	2001	60	59	119	PCI, TRT
Wolf	1987	73	68	141	PCI, TRT
Total: 29	‐	2764	2766	5530	‐
PCI ‐ Prophylactic Cranial Irradiation TRT ‐ Thoracic Radiotherapy

Table 1. Summary of included studies

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Table 2. Studies by subgroup

Undifferentiated		LD‐SCLC		ED‐SCLC
Creech	1982	Eagan	1981	Chahinian	1989
Farris^	1993	Fukuoka	1986	Fukuoka	1986
Fukuoka^	1991	Goodman	1990	Gatzemeier	1994
Postmus	1992	Havemann	1987	Greco	2005
Sculier	1990	Jones	1993	Havemann	1987
Sculier	1993	Sundstrom	2002	Jones	1993
Smith	1991	Urban*	1999a	Kanitz	1992
Souhami	1997	Wolf	1987	Lyss	2002
Urban	1999b	‐	‐	Postmus	1996
Veronesi	1994	‐	‐	Quoix	2005
White	2001	‐	‐	Roth	1992
‐	‐	‐	‐	Sundstrom	2002
‐	‐	‐	‐	Urban*	1999a
‐	‐	‐	‐	Wampler	1991
‐	‐	‐	‐	Wolf	1987
^Presented undifferentiated survival data; response data sorted by stage. *Presented undifferentiated response data; survival data sorted by stage.

Table 2. Studies by subgroup

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Table 3. Survival by subgroup

Subgroup	% Survival
Subgroup	6 months	12 months	24 months
Undifferentiated	67.59%	30.70%	7.85%
LD‐SCLC	88.86%	58.68%	21.14%
ED‐SCLC	64.96%	30.27%	7.41%

Table 3. Survival by subgroup

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Table 4. Sensitivity analysis ‐ quality

Outcome	All studies	Higher quality studies
6‐month survival	NSSD	NSSD
12‐month survival	NSSD	NSSD
24‐month survival	NSSD	NSSD
Overall response	NSSD	NSSD
Complete response	P	P
Toxic death	NSSD	NSSD
Nausea and Vomiting	NP	NP
Alopecia	NSSD	NP
Infection	NSSD	NSSD
Anaemia	NP	NP
Leukopenia	NSSD	P
Thrombocytopenia	NP	NSSD
Granulocytopenia	NSSD	NSSD
NSSD ‐ No statistically significant difference between treatment groups. P ‐ Statistically significant effect favouring platinum‐based regimens. NP ‐ Statistically significant effect favouring non‐platinum‐based regimens.

Table 4. Sensitivity analysis ‐ quality

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Table 5. Sensitivity analysis ‐ radiotherapy use

Outcome	All studies	Only studies using radiotherapy
6‐month survival	NSSD	NSSD
12‐month survival	NSSD	NSSD
24‐month survival	NSSD	NSSD
Overall response	NSSD	NSSD
Complete response	P	P
Toxic death	NSSD	NSSD
Nausea and Vomiting	NP	NP
Alopecia	NSSD	NSSD
Infection	NSSD	NSSD
Anaemia	NP	NP
Leukopenia	NSSD	NSSD
Thrombocytopenia	NP	NP
Granulocytopenia	NSSD	NSSD
NSSD ‐ No statistically significant difference between treatment groups. P ‐ Statistically significant effect favouring platinum‐based regimens. NP ‐ Statistically significant effect favouring non‐platinum‐based regimens.

Table 5. Sensitivity analysis ‐ radiotherapy use

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Comparison 1. Treatment Regimens

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 6‐month survival Show forest plot	28	5490	Risk Ratio (M‐H, Random, 95% CI)	1.05 [1.00, 1.09]

1.1 Undifferentiated	10	1808	Risk Ratio (M‐H, Random, 95% CI)	1.02 [0.94, 1.10]
1.2 Limited Disease	8	1044	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.94, 1.07]
1.3 Extensive Disease	16	2638	Risk Ratio (M‐H, Random, 95% CI)	1.11 [1.03, 1.19]
2 12‐month survival Show forest plot	28	5490	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.96, 1.16]

2.1 Undifferentiated	10	1808	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.82, 1.22]
2.2 Limited Disease	8	1044	Risk Ratio (M‐H, Random, 95% CI)	1.14 [0.92, 1.41]
2.3 Extensive Disease	16	2638	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.93, 1.21]
3 24‐month survival Show forest plot	26	5119	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.84, 1.33]

3.1 Undifferentiated	10	1808	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.71, 1.33]
3.2 Limited Disease	8	1044	Risk Ratio (M‐H, Random, 95% CI)	1.11 [0.67, 1.82]
3.3 Extensive Disease	14	2267	Risk Ratio (M‐H, Random, 95% CI)	1.08 [0.68, 1.71]
4 Overall response Show forest plot	28	5104	Risk Ratio (M‐H, Random, 95% CI)	1.06 [0.98, 1.15]

4.1 Undifferentiated	10	1945	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.86, 1.23]
4.2 Limited Disease	8	809	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.94, 1.12]
4.3 Extensive Disease	16	2350	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.97, 1.23]
5 Complete response Show forest plot	27	5054	Risk Ratio (M‐H, Random, 95% CI)	1.33 [1.13, 1.56]

5.1 Undifferentiated	9	1895	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.84, 1.83]
5.2 Limited Disease	8	809	Risk Ratio (M‐H, Random, 95% CI)	1.19 [1.02, 1.40]
5.3 Extensive Disease	16	2350	Risk Ratio (M‐H, Random, 95% CI)	1.48 [1.18, 1.87]
6 Toxic Death Show forest plot	18	3433	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.82, 1.76]

7 Nausea and Vomiting Show forest plot	19	3418	Risk Ratio (M‐H, Random, 95% CI)	1.51 [1.20, 1.90]

8 Alopecia Show forest plot	7	1246	Risk Ratio (M‐H, Random, 95% CI)	1.11 [0.96, 1.27]

9 Infection Show forest plot	10	1643	Risk Ratio (M‐H, Random, 95% CI)	0.82 [0.55, 1.21]

10 Anaemia Show forest plot	9	1676	Risk Ratio (M‐H, Random, 95% CI)	1.60 [1.22, 2.08]

11 Leukopenia Show forest plot	15	2293	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.76, 1.13]

12 Thrombocytopenia Show forest plot	17	3013	Risk Ratio (M‐H, Random, 95% CI)	2.10 [1.54, 2.86]

12.1 New Subgroup	17	3013	Risk Ratio (M‐H, Random, 95% CI)	2.10 [1.54, 2.86]
13 Granulocytopenia Show forest plot	5	1229	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.79, 1.00]

Comparison 1. Treatment Regimens

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