Maintenance or consolidation therapy in small-cell lung cancer: a systematic review and meta-analysis

Lung Cancer. 2010 Nov;70(2):119-28. doi: 10.1016/j.lungcan.2010.02.001. Epub 2010 Feb 25.


Objective: To assess the role of maintenance or consolidation therapy in the treatment of small-cell lung cancer (SCLC), a meta-analysis of all published randomized clinical trials (RCTs) was performed in order to provide an overall meta-analysis and indirectly compare the effect of chemotherapy, interferons, and other biologic agents.

Methods: Electronic databases were searched for publication reporting of RCTs comparing maintenance or consolidation therapy versus placebo or follow-up alone until December 2008. Hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS), with their relative 95% confidence intervals (CI), were derived. In the calculation of HRs, the "no maintenance" arm served as a reference. The a priori value of p<0.05 was chosen as significant level for statistical tests.

Results: Twenty-one RCTs, encompassing 3,688 patients, were eligible for the present analysis: 11 RCTs employing chemotherapy, 6 interferons (4 alpha and 2 gamma), and 4 other biological agents. Overall, no statistical advantage in OS (HR 0.93, 95% CI 0.87-1.00; p = 0.05) or in PFS (HR 0.98, 95% CI 0.91-1.06; p = 0.63) was reported for maintenance or consolidation therapy. Statistical evidence of different effects among the four types of therapy was detected for OS (χ(2) test for heterogeneity: 8.07 [3 df]; p = 0.04), but not for PFS. A statistically significant reduction of mortality was detected in those studies assessing the efficacy of chemotherapy (HR 0.89, 95% CI 0.81-0.98; p = 0.02) and of interferon-alpha (HR 0.78, 95% CI 0.64-0.96; p = 0.02).

Conclusions: The maintenance or the consolidation approach failed to improve the outcomes of SCLC. A survival advantage is suggested for maintenance chemotherapy and interferon-alpha, but its clinical impact needs to be confirmed by further studies.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Carcinoma, Small Cell / diagnosis
  • Carcinoma, Small Cell / immunology
  • Carcinoma, Small Cell / pathology
  • Carcinoma, Small Cell / therapy*
  • Disease-Free Survival
  • Humans
  • Immunotherapy*
  • Interferons / therapeutic use*
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / immunology
  • Lung Neoplasms / pathology
  • Lung Neoplasms / therapy*
  • Randomized Controlled Trials as Topic


  • Interferons