Comparison of the second-line treatments for patients with small cell lung cancer sensitive to previous platinum-based chemotherapy: A systematic review and Bayesian network analysis

Hekai Shi; Nuojin Guo; Zeming Zhao; Ligang Liu; Tianyi Ni; Jinye Zhang; Yingjie Lu

doi:10.3389/fonc.2023.1154685

Comparison of the second-line treatments for patients with small cell lung cancer sensitive to previous platinum-based chemotherapy: A systematic review and Bayesian network analysis

Front Oncol. 2023 Mar 16:13:1154685. doi: 10.3389/fonc.2023.1154685. eCollection 2023.

Authors

Hekai Shi¹, Nuojin Guo², Zeming Zhao³, Ligang Liu⁴, Tianyi Ni¹, Jinye Zhang⁵, Yingjie Lu¹

Affiliations

¹ Department of Thoracic Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China.
² Shanghai East Hospital, Tongji University, Shanghai, China.
³ Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
⁴ Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, The Ohio State University, Columbus, OH, United States.
⁵ First Hospital of Hebei Medical University, Shijiazhuang, China.

Abstract

Objective: It remains unclear what the best second-line treatment is for patients with small-cell lung cancer sensitive to previous platinum-based chemotherapy.

Methods: We systematically screened randomized controlled trials from several online databases. The primary outcome was objective response rate (ORR), and the secondary outcomes were disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and hematological complications graded 3 to 5. The efficacy of included treatments was ranked by surface under the cumulative ranking curve (SUCRA) value.

Results: We included eleven trials involving 1560 patients in quantitative analysis. Triple chemotherapy containing platinum (TP, combination of cisplatin, etoposide, and irinotecan) was associated with favorable ORR (intravenous topotecan vs TP; odds ratio: 0.13, 95% CI:0.03-0.63; SUCRA, 0.94) and PFS (vs intravenous topotecan; hazard ratio, 0.5; 95% CI: 0.25-0.99; SUCRA, 0.90). Belotecan ranked highest for OS (SUCRA, 0.90), while intravenous topotecan plus Ziv-aflibercept ranked highest for DCR (SUCRA, 0.75). TP was more likely to cause anemia and thrombocytopenia while intravenous topotecan plus Ziv-aflibercept resulted in most neutrocytopenia.

Conclusion: TP is the first recommendation for the second-line treatment of sensitive relapsed SCLC. TP achieved priority in ORR and PFS with the most frequent adverse effects in anemia and thrombocytopenia. For patients who cannot tolerate the hematological adverse effects of triple chemotherapy, amrubicin is an optional option. Amrubicin had relatively good ORR and PFS, accompanied by fewer hematological complications. The rechallenge of the platinum doublet is inferior to amrubicin in ORR, DCR, and PFS. Oral topotecan has a similar effect compared with IV topotecan, but oral topotecan was associated with slightly higher safety and less stress in nursing. Belotecan contributed to the best PFS with slightly better safety but was not ideal in other outcomes.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358256.

Keywords: chemotherapy; meta-analysis; relapse; second-line treatment; small cell lung cancer.

Publication types

Systematic Review