scholarly journals Clinical effectiveness of first-line chemoradiation for adult patients with locally advanced non-small cell lung cancer: a systematic review

2013 ◽  
Vol 17 (6) ◽  
pp. 1-99 ◽  
Author(s):  
T Brown ◽  
G Pilkington ◽  
A Boland ◽  
J Oyee ◽  
C Tudur Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advanced Nsclc ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Clinical Effectiveness ◽  
Adult Patients ◽  
Inclusion Criteria ◽  
Stage Iiia ◽  
First Line ◽  
Locally Advanced Nsclc

BackgroundThe National Institute for Health and Clinical Excellence has issued guidelines on the treatment of non-small cell lung cancer (NSCLC) and recommends that patients with stage IIIA–IIIB disease who are not amenable to surgery be treated with potentially curative chemoradiation (CTX-RT). This review was conducted as part of a larger systematic review of all first-line chemotherapy (CTX) and CTX-RT treatments for patients with locally advanced or metastatic NSCLC. However, it was considered that patients with potentially curable disease (e.g. stage IIIA) are different from those with advanced disease, who are suitable for palliative treatment only, and therefore the results should be reported separately.ObjectiveTo evaluate the clinical effectiveness of first-line CTX in addition to radiotherapy (RT) (CTX-RT vs CTX-RT) for adult patients with locally advanced NSCLC who are suitable for potentially curative treatment.Data sourcesThree electronic databases (MEDLINE, EMBASE and The Cochrane Library) were searched from January 1990 to September 2010.Review methodsInclusion criteria comprised adult patients with locally advanced NSCLC, trials that compared any first-line CTX-RT therapy (induction, sequential, concurrent and consolidation) and outcomes of overall survival (OS) and/or progression-free survival (PFS). The results of clinical data extraction and quality assessment were summarised in tables and with narrative description. Direct meta-analyses using OS data were undertaken where possible: sequential CTX-RT compared with concurrent CTX-RT; sequential CTX-RT compared with concurrent/consolidation CTX-RT; and sequential CTX-RT compared with concurrent CTX-RT with or without consolidation. There were not sufficient data to perform meta-analysis on PFS.ResultsOf the 240 potentially relevant studies that were published post 2000, 19 met the inclusion criteria and compared CTX-RT with CTX-RT. The results from the OS meta-analysis comparing sequential CTX-RT with concurrent CTX-RT appear to show an OS advantage for concurrent CTX-RT arms over sequential arms; this result is not statistically significant [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.50 to 1.25)]. The results from the OS meta-analysis comparing sequential CTX-RT with concurrent/consolidation CTX-RT appear to show a statistically significant OS advantage for concurrent/consolidation CTX-RT treatment over sequential treatment (HR 0.68; 95% CI 0.55 to 0.83). The results from the OS meta-analysis comparing sequential CTX-RT with concurrent CTX-RT with or without consolidation appear to show a statistically significant OS advantage for concurrent CTX-RT with or without consolidation over sequential treatment (HR 0.72; 95% CI 0.61 to 0.84).LimitationsThis report provides a summary and critical appraisal of a comprehensive evidence base of CTX-RT trials; however, it is possible that additional trials have been reported since our last literature search. It is disappointing that the quality of the research in this area does not meet the accepted quality standards regarding trial design and reporting.ConclusionsThis review identified that the research conducted in the area of CTX-RT was generally of poor quality and suffered from a lack of reporting of all important clinical findings, including OS. The 19 trials included in the systematic review were too disparate to form any conclusions as to the effectiveness of individual CTX agents or types of RT. The focus of primary research should be good methodological quality; appropriate allocation of concealment and randomisation, and comprehensive reporting of key outcomes, will enable meaningful synthesis and conclusions to be drawn.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Treatment of Non-neurogenic Overactive Bladder with OnabotulinumtoxinA: Systematic Review and Meta-analysis of Prospective, Randomized, Placebo-controlled Clinical Trials

2018 ◽  
Vol 40 (04) ◽  
pp. 225-231 ◽  
Author(s):  
Raquel Arruda ◽  
Claudia Takano ◽  
Manoel Girão ◽  
Jorge Haddad ◽  
Gabriel Aleixo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overactive Bladder ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Mean Difference ◽  
Intermittent Catheterization ◽  
Inclusion Criteria ◽  
Primary Endpoints ◽  
Jadad Scale ◽  
Bladder Symptoms

AbstractWe performed a systematic review and meta-analysis of randomized placebo-controlled trials that studied non-neurogenic overactive bladder patients who were treated with 100 units of onabotulinumtoxinA or placebo. The primary purpose of our study was to evaluate the clinical effectiveness with regard to urinary urgency, urinary frequency, nocturia, and incontinence episodes. Our secondary purpose consisted of evaluating the adverse effects. Our initial search yielded 532 entries. Of these, seven studies met all the inclusion criteria (prospective, randomized, placebo-controlled studies, ≥ 3 points on the Jadad scale) and were selected for analysis. For all primary endpoints, the toxin was more effective than placebo (p < 0.0001; 95% confidence interval [95CI]), namely: urgency (mean difference = -2.07; 95CI = [-2.55–1.58]), voiding frequency (mean difference = -1.64; 95CI = [-2.10–1.18]), nocturia (mean difference = -0.25; 95CI = [-0.39–0.11]) and incontinence episodes (mean difference = -2.06; 95CI= [-2.60–1.52]). The need for intermittent catheterization and the occurrence of urinary tract infection (UTI) were more frequent in patients treated with onabotulinumtoxinA than in patients treated with placebo (p < 0.0001). Compared with placebo, onabotulinumtoxinA had significantly and clinically relevant reductions in overactive bladder symptoms and is associated with higher incidence of intermittent catheterization and UTI.

High efficacy of paclitaxel (P), carboplatin (C) and concurrent thoracic radiation therapy (TRT) for locally advanced non-small cell lung cancer (NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17143-17143
Author(s):  
K. Kishi ◽  
A. Okazaki ◽  
H. Takaya ◽  
A. Miyamoto ◽  
S. Sakamoto ◽  
...  
Keyword(s):  
Weight Loss ◽  
Advanced Nsclc ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Chemotherapeutic Agents ◽  
Stage Iiia ◽  
Number Of Patients ◽  
Locally Advanced Nsclc ◽  
Thoracic Radiation ◽  
Grade 3

17143 Background: Combined modality therapy with P, C and radiation for locally advanced NSCLC is active, but its clinical data are limited in Japan. The aim of this study is to evaluate feasibility and efficacy of the therapy in a Japanese general hospital. Methods: Patients with previously untreated and locally advanced NSCLC with stage IIIA and IIIB (PS 0–1, weight loss less than 5% over past 3 months) were treated with P (40 mg/m2 on days 1,8,15, 22, 29, 36, 43), C (AUC 2 on days 1,8,15, 22, 29, 36, 43) and TRT (66 Gy/33fr over 6.5 weeks starting on day1). Results: Fifteen evaluable patients entered this study between December 2001 and March 2005. They were 12 males, 3 females, with median age 67 (57–76); 6 patients with ECOG PS 0, 9 with PS 1, 8 with stage IIIA, and 7 with IIIB. Chemotherapeutic agents were administered a median of 6 cycles (4–7) and 66 Gy of TRT done in 14 patients. It achieved 13 PRs, 1 SD and 1 PD with a response rate of 86.7%. Survival was 85.5% at 1 year, 66.0% at 2 year and 66.0% at 3 year. Eleven patients are still alive. A relapse occurred in 10 patients (66.7%) and 5 were disease-free (33.3%). The site of first relapse was distant in 5 patients, local in 3, and both local and distant in 2. Toxicity was mild: grade 3 neutropenia in 2 patients, grade 3 nausea in 1, and grade 3 esophagitis in 1. No grade 3/4 pneumonitis was observed. After completion of chemoradiotherapy scheduled, 2 patients received additional chemotherapy of PC and 1 underwent lobectomy. Conclusion: Although the number of patients is small in this study, concurrent PC and TRT for locally advanced NSCLC is feasible and highly effective for Japanese patients with good PS and minimal weight loss. No significant financial relationships to disclose.

scholarly journals Radiation dose escalation with modified fractionation schedules for locally advanced NSCLC : A systematic review

2020 ◽  
Vol 11 (6) ◽  
pp. 1375-1385
Author(s):  
Franz Zehentmayr ◽  
Brane Grambozov ◽  
Julia Kaiser ◽  
Gerd Fastner ◽  
Felix Sedlmayer
Keyword(s):  
Systematic Review ◽  
Radiation Dose ◽  
Dose Escalation ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Locally Advanced Nsclc ◽  
Fractionation Schedules

scholarly journals Surgery after chemoradiotherapy in patients with stage III (N2 or N3, excluding T4) non-small cell lung cancer: a systematic review

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
A. Swaminath ◽  
E. T. Vella ◽  
K. Ramchandar ◽  
A. Robinson ◽  
C. Simone ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Iii ◽  
Small Cell Lung ◽  
Locally Advanced Nsclc

Background: Chemoradiation with curative intent is considered standard of care in patients with locally-advanced, stage III non-small cell lung cancer (NSCLC). However, there may be patients with stage III (N2 or N3, including T4) NSCLC who may be eligible for surgery. The objective of this systematic review was to investigate the efficacy of surgery after chemoradiotherapy compared with chemoradiotherapy alone in patients with locally-advanced NSCLC.Methods: MEDLINE, EMBASE, and PubMed were searched for randomized controlled trials (RCTs) comparing surgery after chemoradiotherapy versus chemoradiotherapy alone in patients with stage III (N2 or N3, excluding T4) NSCLC.Results: Three included RCTs consistently found no statistically significant difference in overall survival between patients with locally-advanced NSCLC who received surgery and chemoradiotherapy or chemoradiotherapy alone. Only one RCT found a significantly longer progression-free survival (PFS) in patients treated with chemoradiation and surgery (HR, 0.77; 95% confidence interval [CI], 0.62 to 0.96). In a post-hoc analysis of the same trial, the rate of overall survival was higher in the surgical group compared with patients matched in the chemoradiation-alone group if a lobectomy was performed (p=0.002), but not when a pneumonectomy was performed. Furthermore, fewer treatment-related deaths occurred among patients who received lobectomy compared with pneumonectomy.Conclusion: For patients with locally-advanced NSCLC, the benefits of surgery following chemoradiation were uncertain. Surgery after chemoradiation for patients who do not require a pneumonectomy may be an option.

Safety evaluation of nivolumab added concurrently to radiotherapy in a standard first line chemo-RT regimen in unresectable locally advanced NSCLC: The ETOP NICOLAS phase II trial.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 8510-8510 ◽  
Author(s):  
Solange Peters ◽  
Dirk De Ruysscher ◽  
Urania Dafni ◽  
Enriqueta Felip ◽  
Matthias Guckenberger ◽  
...  
Keyword(s):  
Phase Ii ◽  
Advanced Nsclc ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Safety Evaluation ◽  
First Line ◽  
Locally Advanced Nsclc

scholarly journals Efficacy of erlotinib as neoadjuvant regimen in EGFR-mutant locally advanced non-small cell lung cancer patients

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988727 ◽  
Author(s):  
Liwen Xiong ◽  
Yuqing Lou ◽  
Hao Bai ◽  
Rong Li ◽  
Jinjing Xia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Advanced Nsclc ◽  
Response Rate ◽  
Locally Advanced ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Locally Advanced Nsclc ◽  
Iiia Nsclc ◽  
Egfr Mutant

Background The optimal neoadjuvant regimen for locally advanced resectable non-small cell lung cancer (NSCLC) remains controversial. EGFR inhibitors have significantly improved survival in patients with EGFR-mutant advanced NSCLC. However, their efficacy in neoadjuvant settings, particularly for treating locally advanced NSCLC, remains unclear. We compared the clinical benefits of chemotherapy and erlotinib as neoadjuvant therapy for stage IIIA NSCLC. Method Thirty-one treatment-naïve Chinese patients with stage IIIA NSCLC were enrolled. Patients without EGFR mutation received cisplatin-based doublet chemotherapy (n = 16; N-chemo group) while EGFR-mutant patients received erlotinib (n = 15; N-TKI group) as neoadjuvant therapy. Results After completing neoadjuvant treatment, 12 and 8 patients from the N-TKI and N-chemo groups underwent surgery, respectively. Our data revealed that patients who received erlotinib had a marginally better clinical objective response rate (67% vs. 19%), pathological response rate (67% vs. 38%), and overall survival (51.0 months vs. 20.9 months) compared with those who received chemotherapy. Furthermore, patients in the N-TKI group had a significantly greater reduction in tumor diameter, serum carcinoembryonic level, and maximum allelic fraction. Conclusion Our findings demonstrate that erlotinib is an effective neoadjuvant regimen in patients with EGFR-mutant locally advanced NSCLC, paving the way for its extended use in neoadjuvant settings. [ClinicalTrials.gov identifier: NCT01217619]

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