Local consolidative therapy versus systemic therapy alone for metastatic non-small cell lung cancer: a systematic review and meta-analysis
Abstract
PURPOSE
The role of local consolidative therapy (LCT) for metastatic cancers varies by the particular cancer type. We therefore performed a systematic review with a comparative meta-analysis of LCT versus systemic therapy alone specifically for metastatic non-small cell lung cancer (mNSCLC) Methods: Article eligibility for this PRISMA/PICOD-guided systematic review was histologic confirmation of mNSCLC, comparison of LCT (irradiation/surgery) vs. lack thereof in a randomized or propensity-matched retrospective manner, and sufficient quantitative data examining progression-free survival (PFS), overall survival (OS), and/or adverse events (AEs). Both polymetastatic and oligometastatic disease (OMD) was allowed, but not oligoprogressive/oligorecurrent disease. Statistics utilized the Mantel-Haenszel fixed-effect or random-effect model depending on the heterogeneity (I2).
RESULTS
From 7 articles, 346 patients received LCT and 347 received systemic therapy alone. With LCT, the hazard ratio (HR) for PFS in all patients was 0.37 (95% confidence interval (CI) 0.25-0.55, p=0.01), and for OMD was 0.30 (0.24-0.38, p<0.001). For OS, the HRs were 0.53 (0.45-0.62, p<0.001) in all patients and 0.41 (0.33-0.52, p<0.001) in OMD patients. The findings remained significant when stratifying by EGFR status (HRs for PFS/OS: 0.29/0.44 for mutants and 0.31/0.39 for wild-type, respectively, p<0.001 for all) and study type (HRs for PFS/OS: 0.40/0.52 for randomized and 0.33/0.41 for retrospective,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 346 participants or records.
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