NEWS & VIEWS LUNG CANCER
How much platinum-based chemotherapy is enough in NSCLC? Solange Peters and Alex A. Adjei
With no large randomized phase III trials to provide definitive answers, the ideal number of platinum-based chemotherapy cycles in patients with advanced non-small-cell lung cancer has long been unclear. Most guidelines recommend a maximum of 4–6 cycles. Rossi and colleagues now suggest that four chemotherapy cycles is the optimal regimen. Peters, S. & Adjei, A. A. Nat. Rev. Clin. Oncol. advance online publication 2 December 2014; doi:10.1038/nrclinonc.2014.212
Currently, all international treatment guide lines for the first-line treatment of patients with non-small-cell lung cancer (NSCLC) and a good performance status who lack actionable molecular aberrations recom mend the systemic delivery of 4–6 cycles of a platinum doublet, 1,2 highlighting a lack of evidence-based guidance on the optimal number of cycles to be delivered. Rossi and colleagues have recently reported the first systematic meta-analysis of indivi dual patient data comparing the overall survival of patients receiving six cycles versus three or four cycles of first-line platinum-based chemotherapy.3
‘‘
…the time has come to firmly establish the standard of care in unselected patients with NSCLC…
’’
Prior to this study, the available prospec tive clinical trials have been underpowered and insufficient to draw firm conclusions; the results of this latest study, therefore, provides important information to guide patient care and future clinical trial designs. This meta-analysis3 collected data from four randomized trials, 4–7 which used carbo platin as well as cisplatin-based regimens for the first-line treatment of patients with advanced-stage NSCLC; moreover, in the two treatment groups of this meta-analysis, there was comparable delivery of second-line treatments.3 Thus, two potential confound ing factors were accounted for. On the basis of their analysis, Rossi et al.3 were able to
conclude that six cycles of cisplatin-based or carboplatin-based chemotherapy do not result in a better overall survival when com pared to 3–4 cycles of therapy. Interestingly, the exploratory subgroup analysis that assessed gender, age (>70 years versus
How much platinum-based chemotherapy is enough in NSCLC? Solange Peters and Alex A. Adjei
With no large randomized phase III trials to provide definitive answers, the ideal number of platinum-based chemotherapy cycles in patients with advanced non-small-cell lung cancer has long been unclear. Most guidelines recommend a maximum of 4–6 cycles. Rossi and colleagues now suggest that four chemotherapy cycles is the optimal regimen. Peters, S. & Adjei, A. A. Nat. Rev. Clin. Oncol. advance online publication 2 December 2014; doi:10.1038/nrclinonc.2014.212
Currently, all international treatment guide lines for the first-line treatment of patients with non-small-cell lung cancer (NSCLC) and a good performance status who lack actionable molecular aberrations recom mend the systemic delivery of 4–6 cycles of a platinum doublet, 1,2 highlighting a lack of evidence-based guidance on the optimal number of cycles to be delivered. Rossi and colleagues have recently reported the first systematic meta-analysis of indivi dual patient data comparing the overall survival of patients receiving six cycles versus three or four cycles of first-line platinum-based chemotherapy.3
‘‘
…the time has come to firmly establish the standard of care in unselected patients with NSCLC…
’’
Prior to this study, the available prospec tive clinical trials have been underpowered and insufficient to draw firm conclusions; the results of this latest study, therefore, provides important information to guide patient care and future clinical trial designs. This meta-analysis3 collected data from four randomized trials, 4–7 which used carbo platin as well as cisplatin-based regimens for the first-line treatment of patients with advanced-stage NSCLC; moreover, in the two treatment groups of this meta-analysis, there was comparable delivery of second-line treatments.3 Thus, two potential confound ing factors were accounted for. On the basis of their analysis, Rossi et al.3 were able to
conclude that six cycles of cisplatin-based or carboplatin-based chemotherapy do not result in a better overall survival when com pared to 3–4 cycles of therapy. Interestingly, the exploratory subgroup analysis that assessed gender, age (>70 years versus
