|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 23, No 4 (February 1), 2005: pp. 924-925 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.303
Chemotherapy in Non-Small-Cell Lung Cancer: An Update of an Individual Patient Data Meta-AnalysisMeta-Analysis Group, MRC Clinical Trials Unit, London, UK
Service de Biostatistique et d'Epidemiologie, Institut Gustave-Roussy, Villejuif, France To the Editor: Hotta et al1 have reported a meta-analysis of postoperative chemotherapy versus surgery alone in non-small-cell lung cancer (NSCLC). This meta-analysis is based on abstracted data from 11 randomized controlled trials (RCTs) that included 5,716 patients. These 11 RCTs have been published since 1995, when an individual patient data-based (IPD) meta-analysis2 assessing the value of chemotherapy in this disease was published. The NSCLC Collaborative Group was responsible for the IPD meta-analysis published in 1995, and we welcome the meta-analysis provided by Hotta et al,1 which was a thoughtful and well done meta-analysis with data abstracted from publications. However, we wholeheartedly agree with the Editorial by Piedbois and Buyse3 who point out the inherent difficulties of meta-analyses that use data from published reports and highlight the advantages and increased reliability of the IPD approach. Both publications1,3 conclude that an IPD meta-analysis should be carried out in order to verify these results and we are pleased to confirm that we are in the process of updating the 1995 meta-analysis. The 1995 meta-analysis included more than 9,000 patients from 52 RCTs. It assessed the effect of chemotherapy in four different settings. Since the meta-analysis publication, there has been renewed enthusiasm for investigations of chemotherapy in NSCLC, and a considerable number of new RCTs have been completed. The total number of patients randomly assigned has risen to approximately 23,000 patients. As the aim of the NSCLC Collaborative Group is to provide an up-to-date and reliable review of the role of chemotherapy, both to act as a sound basis for evidence based medicine and to help guide future research, it was decided that an update was timely. A number of new agents and timings have been investigated in all settings, and the update consists of adding trials published since the 1995 analyses and additional follow-up data from trials already included, as well as looking at additional outcomes in certain settings. We are also investigating the effect of chemotherapy in three additional settings (comparisons 2, 5, and 6), bringing the total to seven: (1) surgery versus surgery plus chemotherapy (adjuvant); (2) surgery versus chemotherapy plus surgery (neoadjuvant); (3) surgery plus radiotherapy versus surgery plus radiotherapy plus chemotherapy; (4) radiotherapy versus sequential radiotherapy plus sequential chemotherapy; (5) radiotherapy versus radiotherapy plus concomitant chemotherapy; (6) radiotherapy plus sequential chemotherapy versus radiotherapy plus concomitant chemotherapy; (7) supportive care versus supportive care plus chemotherapy. For the update of the 1995 meta-analyses, we have identified a total of 22 new RCTs with more than 8,000 patients in the equivalent setting to that which is described by Hotta et al, bringing the total number of trials to 38. If we can include these patients, it would bring the total number of patients in this comparison alone to more than 10,500 patients. As Piedbois and Buyse point out, IPD meta-analyses are considered the gold standard but need time and funding. This meta-analysis by Hotta et al, is a valuable resource in the absence of other evidence, but the results should be considered with caution until they can be compared with the updated IPD meta-analysis. Authors' Disclosures of Potential Conflicts of Interest The following authors or their immediate family members have indicated a financial interest. No conflict exists for drugs or devices used in a study if they are not being evaluated as part of the investigation. Honoraria: Jean-Pierre Pignon, Lilly. Research Funding: Jean-Pierre Pignon, Aventis. For a detailed description of these categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section of Information for Contributors found in the front of every issue. REFERENCES
1. Hotta K, Matsuo K, Ueoka H, et al: Role of adjuvant chemotherapy in patients with resected non-small cell lung cancer: Reappraisal with a meta-analysis of randomised controlled trials. J Clin Oncol 22:3860-3867, 2004
2. Non-Small Cell Lung Cancer Collaborative Group: Chemotherapy in non-small cell lung cancer: A meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ 311:899-909, 1995
3. Piedbois P, Buyse M: Meta-analysis based on abstracted data: A step in the right direction, but only a first step. J Clin Oncol 22:3839-3841, 2004
Related Article
Related Reply
This article has been cited by other articles:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
