A systematic review of survival following anti-cancer treatment for small cell lung cancer

Gavin S Jones; Kelly Elimian; David R Baldwin; Richard B Hubbard; Tricia M McKeever

doi:10.1016/j.lungcan.2019.12.015

A systematic review of survival following anti-cancer treatment for small cell lung cancer

Lung Cancer. 2020 Mar:141:44-55. doi: 10.1016/j.lungcan.2019.12.015. Epub 2020 Jan 11.

Authors

Gavin S Jones¹, Kelly Elimian², David R Baldwin³, Richard B Hubbard⁴, Tricia M McKeever⁵

Affiliations

¹ Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK. Electronic address: Gavin.jones@nottingham.ac.uk.
² Division of Epidemiology and Public Health, University of Nottingham, NG5 1PB, UK. Electronic address: Kelly.elimian@nottingham.ac.uk.
³ Division of Epidemiology and Public Health, University of Nottingham, Department of Respiratory Medicine, Nottingham University Hospitals, UK. Electronic address: David.baldwin@nottingham.ac.uk.
⁴ Division of Epidemiology and Public Health, University of Nottingham, UK. Electronic address: Richard.hubbard@nottingham.ac.uk.
⁵ Division of Epidemiology and Public Health, University of Nottingham, UK. Electronic address: Tricia.mckeever@nottingham.ac.uk.

PMID: 31955000
DOI: 10.1016/j.lungcan.2019.12.015

Abstract

Objectives: We conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with.

Materials and methods: Randomized controlled trials and observational studies reporting overall survival following chemotherapy for SCLC were included. We calculated survival at 30 and 90-days along with 1-year, 2-year and median.

Results: We identified 160 for inclusion. There were minimal 30-day deaths. Survival was 99 % (95 %CI 98.0-99.0 %, I²33.9 %, n = 77) and 90 % (95 %CI 89.0-92.0 %, I²79.5 %, n = 73) at 90 days for limited (LD-SCLC) and extensive stage (ED-SCLC) respectively. The median survival for LD-SCLC was 18.1 months (95 %CI 17.0-19.1 %, I²77.3 %, n = 110) and early thoracic radiotherapy (thoracic radiotherapy 18.4 months (95 %CI 17.3-19.5, I²78.4 %, n = 100)) vs no radiotherapy 11.7 months (95 %CI 9.1-14.3, n = 10), prophylactic cranial irradiation (PCI 19.7 months vs No PCI 13.0 months (95 %CI 18.5-21.0, I²75.7 %, n = 78 and 95 %CI 10.5-16.6, I²81.1 %, n = 15 respectively)) and better performance status (PS0-1 22.5 months vs PS0-4 15.3 months (95 %CI 18.7-26.1, I²72.4 %, n = 11 and 95 %CI 11.5-19.1 I²77.9 %, n = 13)) augmented this. For ED-SCLC the median survival was 9.6 months (95 %CI 8.9-10.3 %, I²95.2 %, n = 103) and this improved when irinotecan + cisplatin was used, however studies that used this combination were mostly conducted in Asian populations where survival was better. Survival was not improved with the addition of thoracic radiotherapy or PCI. Survival for both stages of cancer was better in modern studies and Asian cohorts. It was poorer for studies administering carboplatin + etoposide but this regimen was used in studies that had fewer patient selection criteria.

Conclusion: Early thoracic radiotherapy and PCI should be offered to people with LD-SCLC in accordance with guideline recommendations. The benefit of the aforementioned therapies to treat ED-SCLC and the use of chemotherapy in people with poor PS is less clear.

Keywords: 30-day survival; Chemotherapy; Epidemiology; Radiotherapy; SCLC survival.

Publication types

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

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Humans
Lung Neoplasms / drug therapy
Lung Neoplasms / mortality*
Lung Neoplasms / pathology
Observational Studies as Topic
Prognosis
Randomized Controlled Trials as Topic
Small Cell Lung Carcinoma / drug therapy
Small Cell Lung Carcinoma / mortality*
Small Cell Lung Carcinoma / pathology
Survival Rate