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Abstract
Background:
Two new agents have recently been licensed as maintenance therapy for advanced non-small-cell lung cancer (NSCLC) by the US Food and Drug Administration. This paper aims to systematically review the evidence from all available clinical trials of erlotinib and pemetrexed as maintenance therapy for advanced NSCLC.
Methods:
Systematic literature searches were performed in PUBMED, EMBASE and Cochrane databases. Abstracts presented at two conferences were also researched. The effects of erlotinib and pemetrexed on overall survival and progression-free survival were compared using an indirect treatment comparison method with placebo or observation as a common comparator.
Results:
Five randomized controlled studies were included. Both interventions offered significant advantages for overall survival (OS) and progression-free survival (PFS) compared with placebo or observation. Using indirect comparison meta-analysis, the relative hazards ratio of pemetrexed compared with erlotinib for PFS was 0.71 (95% CI 0.60–0.85; p = 0.0001), suggested that pemetrexed was superior to erlotinib in terms of progression-free survival. Although relative hazards ratio for OS showed no significant difference between the two agents (HR 0.88; 95% CI 0.71–1.08, p = 0.22).
Conclusions:
There is evidence to suggest that maintenance treatment with erlotinib or pemetrexed has clinically relevant and statistically significant advantages over treatment with placebo or observation in patients with advanced NSCLC.
Transparency
Declaration of funding
The study was supported by the National Natural Science Foundation of China (Grant No.81001191) and Science and Technology Commission of Shanghai (Grant No. 10PJ1408300).
Declaration of financial/other relationships
W.X.Q., L.-n.T., A.-n.H., Z.S., F.L., and Y.Y. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.
Acknowledgements
W.X.Q., L.-n.T., and Z.S. conducted the search, data selection and data extraction up to March 2011. W.X.Q., A.-n.H., and F.L. did the updated literature search, data extraction, study selection, statistical analyses and wrote the first draft of the original manuscript. Y.Y. was expert statistical advisor and contributed towards the statistical analyses. All authors contributed to the revision of the manuscript. The views expressed in this review are the opinions of the authors. All authors had full access to all the data in the study. W.X.Q. and Y.Y. take responsibility for the integrity of the data and the accuracy of the data analysis.