Systematic review and meta-analysis of third-line salvage therapy for the treatment of advanced non-small-cell lung cancer: A meta-analysis of randomized controlled trials

Nan Zhang _, Nan Guo, Liang Tian and Zhigang Miao

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Oncotarget. 2018; 9:35439-35447. https://doi.org/10.18632/oncotarget.24967

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Nan Zhang1, Nan Guo2, Liang Tian3 and Zhigang Miao3

1Department of Thoracic Surgery, Cangzhou Central Hospital, Cangzhou, Hebei Province, China

2Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China

3Department of Pathology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China

Correspondence to:

Nan Guo, email: [email protected]

Keywords: non-small-cell lung cancer; third-line therapy; heavily pretreated; meta-analysis

Received: August 15, 2017     Accepted: October 28, 2017     Epub: March 23, 2018     Published: October 23, 2018


Purpose: We performed a systematic review and meta-analysis to investigate the efficacy of third-line treatment for advanced non-small-cell lung cancer (NSCLC).

Materials and Methods: Relevant trials were identified by searching electronic databases and conference meetings. Prospective randomized controlled trials (RCTs) assessing third-line therapy in advanced NSCLC patients were included. Outcomes of interest included overall survival (OS) and progression-free survival (PFS).

Results: A total of 1,985 advanced NSCLC patients received third-line treatment from 11 RCTs were included for analysis. The use of single targeted agent as third-line therapy for advanced NSCLC did not significantly improved PFS (HR 0.75, 95% CI: 0.28–2.04, p = 0.58) and OS (HR 1.01, 95% CI: 0.86–1.17, p = 0.95) when compared to docetaxel alone. In addition, erlotinib-based doublet combination therapy did not significantly improved PFS (HR 0.94, 95% CI: 0.78–1.13, p = 0.49) and OS (HR 1.08, 95% CI: 0.78–1.51, p = 0.65) in comparison with erlotinib alone.

Conclusions: The findings of this study show that the efficacy of single novel targeted agent is comparable to that of docetaxel alone in terms of PFS and OS for heavily pretreated NSCLC patients. In addition, no survival benefits are obtained from erlotinib-based doublet therapy, thus single agent erlotinib could be recommended as third-line treatment for unselected advanced NSCLC patients.

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