Published in:
01-12-2011
The Role of Vandetanib in the Second-Line Treatment for Advanced Non-Small-Cell-Lung Cancer: A Meta-Analysis of Four Randomized Controlled Trials
Published in: Lung | Issue 6/2011
Login to get accessAbstract
Background
The purpose of this study was to assess the efficacy and toxicity of vandetanib in the second-line treatment for advanced non-small cell lung cancer (NSCLC).
Methods
We systematically searched for randomized clinical trials that compared therapy with vandetanib versus standard second-line treatment, including docetaxel, pemetrexed, erlotinib, or gefitinib, as second-line treatment for patients with histologically proven non-small-cell lung cancer. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival, overall response rate, and grade 3 or 4 toxicity. Data were extracted from the studies by two independent reviewers. The meta-analysis was performed by Stata version 10.0 software (Stata Corporation, College Station, TX, USA).
Results
Four randomized clinical trials (N = 3,292 patients) were eligible. Meta-analysis showed that there was significant improvement in PFS (hazards ration (HR), 0.91; 95% confidence interval (CI), 0.83−1.00; P = 0.039) and overall response rate (relative risk (RR), 1.49; 95% CI, 1.04−2.14; P = 0.03) in therapy with vandetanib group compared with standard second-line therapy group, although the pooled HR for overall survival (HR, 0.95; 95% CI, 0.88−1.03; P = 0.191) showed no significant difference between the two groups. In addition, there were less incidences of grade 3 or 4 anemia (RR, 0.39; 95% CI, 0.22−0.67; P = 0.001) in therapy with vandetanib group. With regard to the risk of grade 3 or 4 neutropenia (RR, 1.19; 95% CI, 1.0–1.43; P = 0.054), diarrhea (RR, 1.38; 95% CI, 1.0−1.94; P = 0.059), nausea and vomiting (RR, 0.77; 95% CI, 0.48−1.26; P = 0.308), rash (RR, 2.83; 95% CI, 0.73−10.9; P = 0.131), cough (RR, 1.19; 95% CI, 1.0−1.43; P = 0.054), and fatigue (RR, 1.0; 95% CI, 0.747−1.35; P = 0.971), there was no significant difference between the two groups.
Conclusions
Therapy with vandetanib offered a clinically meaningful and statistically significant improvement in PFS and ORR in patients with advanced NSCLC but did not benefit overall survival. Therapy with vandetanib regimens might be suggested as second-line treatment for advanced NSCLC based on a similar toxicity profile compared with standard second-line therapy.