In a nutshell
This trial investigated whether chemotherapy drugs belonging to the class of camptothecins (such as irinotecan or topotecan) used together with platinum analog chemotherapy (such as cisplatin or carboplatin) were better than the standard regimens in treating extensive disease small-cell lung cancer.
Some background
Standard treatment for extensive disease small-cell lung cancer typically involves the combination of the drug etoposide with cisplatin or carboplatin. Cisplatin and carboplatin belong to the class of drugs called platinum analogs which inhibit the growth of cells and delay the spread of the cancer. However, the vast majority of patients treated with standard chemotherapy experience a relapse after 6 to 8 months. This emphasizes the need for the examination of new treatment strategies. Previous trials have shown improvements in the overall survival of patients that receive irinotecan or topotecan along with platinum analog chemotherapy.
Methods & findings
This study was performed using data derived from 8 previous trials, with a pooled number of participants of 3086. One group of patients in the analysis received the standard chemotherapy regimen (EP treatment; etoposide plus a platinum analog), while the other group received alternative regimens with irinotecan or topotecan plus a platinum analog. Researchers compared overall survival, progression free survival (PFS; the amount of time without disease progression or worsening after treatment) and tumor response to treatment between the two groups.
Results showed that statistically significant improvements in overall survival were obtained with an irinotecan-platinum analog regimen compared to standard EP treatment. PFS was also significantly improved with an irinotecan-platinum analog combination, while tumor response rate did not differ significantly.
The bottom line
Irinotecan-platinum analog combinations were found to be more effective than the standard etoposide-platinum analog regimen in treating extensive stage small-cell lung cancer patients.
The fine print
It is important to note that this study involved a statistical analysis of several already published trials. Trials that directly compare irinotecan/topotecan plus platinum analog regimens to the standard etoposide-platinum analog regimen are needed to confirm these results.
What’s next?
Consult with your physician regarding the benefits and risks of the different chemotherapy combinations available for the treatment of extensive small-cell lung cancer.
Published By :
Journal of Thoracic Oncology
Date :
Dec 01, 2010
What is “statistically significant”? Weeks? Months?
Cassie, thank you for your inquiry.
This meta-analysis combined data from several different trials, including patients at different stages, ages and overall health status, and treated with different drugs for different durations. To account for all these variables, and present results that have a high degree of statistical certainty, data after statistical analysis is presented as the abstract value of change in the risk for an event. For instance, after accounting for all variables, the risk for death was 13% lower with irinotecan therapy. This might translate to a few months in the case of some women, or a few weeks in the case of others.