Chemotherapy vs supportive care in advanced non-small-cell lung cancer. Results of a meta-analysis of the literature.

Abstract

STUDY OBJECTIVE: To contribute to the current debate about the relative merits of meta-analysis of the literature (MAL) and of individual patients data (MAP). DESIGN: Identification of published randomized trials and extraction of essential results directly from the published reports. SETTING: Chemotherapy vs supportive care in advanced non-small-cell lung cancer. MEASUREMENTS AND RESULTS: Survival probability at 6 months after randomization, as estimated from the published survival curves, has been considered as the end-point of interest. Quality scoring of the studies has also been performed. Specific methodologic issues concerning the estimation of relevant quantities necessary for the MAL have been addressed. The estimated pooled odds ratio of death was 0.44, with 95 percent confidence interval of 0.32 to 0.59, thus significantly favoring chemotherapy, and it corresponds to an estimated increase in median survival from 3.9 months for best supportive care to 6.7 for chemotherapy. CONCLUSIONS: The results of our MAL, favoring chemotherapy, are in line with those of a MAP recently published. However, they have to be considered in the light of their actual clinical relevance and of the balance between quality of life, toxicity, and costs of chemotherapy and best supportive care.