The Influence of the Evolution of First-Line Chemotherapy on Steadily Improving Survival in Advanced Non–Small-Cell Lung Cancer Clinical Trials. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: Noonan, Krista L.; Ho, Cheryl; Laskin, Janessa; Murray, Nevin
• Is Part Of: Journal of thoracic oncology. Volume 10:Issue 11(2015)
• Publication Date: 2015-11
• Subjects: Non–small-cell lung cancer -- Palliative chemotherapy -- Critical review; Chest -- Cancer -- Periodicals; Thoracic Neoplasms -- Periodicals; 616.99494005
• DOI: 10.1097/JTO.0000000000000667
• Languages: English
• ISSNs: 1556-0864

Abstract

Abstract : Over the past three decades, survival in advanced non–small-cell lung cancer (NSCLC) clinical trials has doubled with an increase in 1-year survival from 25% to 50 to 55%. This has been mainly attributed to improvements in systemic therapy. Although modern first-line chemotherapy regimens have more favorable toxicity profiles, a statistically significant improvement in overall survival has not been demonstrated in existing meta-analyses of second-generation versus third-generation combinations. Moreover, pivotal trials demonstrating statistically significant survival superiority of third-generation regimens are consistently not reproducible even for nonsquamous populations using pemetrexed–platinum combinations. As enhancement in the efficacy of first-line systemic therapy in patients without identifiable driver mutations is questionable, other factors are discussed that explain the doubling of 1-year survival reported in clinical trials. These factors include second-line or third-line therapy, maintenance chemotherapy, performance status selection, stage migration, sex migration, improved treatment of brain metastases, and better palliative care.