Background and objective: It remains disputed whether doublets are more effective than single-agent chemotherapy for elderly patients with advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy and safety of doublets and single-agent chemotherapy for elderly patients with NSCLC.
Methods: Data from all published, randomized trials that compared doublets and single-agent chemotherapy in elderly patients were collected from electronic databases (PubMed, EMBASE, Cochrane Library, CNKI and the CBMdice). Meta-analysis was completed using software Stata 11.0.
Results: The results of the meta-analysis, including 12 eligible trials (2,306 patients), showed that the doublets significantly increased the overall response rate (OR=1.80, 95%CI:1.50-2.17, P<0.000,1) and one-year survival rate (OR=1.45, 95%CI: 1.22-1.72, P<0.000,1) compared with single-agent chemotherapy. The results of one-year survival rate in platinum-based doublet chemotherapy arms (OR=1.55, 95%CI: 1.18-2.03, P=0.001) and non platinum-based ones (OR=1.38, 95%CI: 1.10-1.73, P=0.006) were both significantly higher than that of single-agent chemotherapy. However, grade 3/4 anemia, neutropenia, thrombocytopenia and neurotoxicity (P<0.05) were significantly associated with doublet chemotherapy. The incidence of toxicity effect in non platinum-based chemotherapy was similar to that of single-agent chemotherapy.
Conclusions: Compared with single-agent chemotherapy, doublet chemotherapy could increase the overall response rate and one-year survival rate significantly. Therefore, doublet chemotherapy would be more appropriate for elderly patients with advanced NSCLC as the first-line chemotherapy regimen. However, further prospective randomized controlled trials in elderly NSCLC patients is needed to verify the findings in this study.
背景与目的: 双药方案治疗老年晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）的疗效是否优于单药化疗尚存争议，本研究旨在对双药方案治疗老年晚期NSCLC患者的有效性和安全性进行系统评价。
方法: 计算机检索PubMed、EMBASE、Cochrane Library、中国期刊全文数据库和中国生物医学文献等数据库，收集双药方案治疗老年晚期NSCLC的随机对照试验，用Stata 11.0软件对数据进行meta分析。
结果: 共纳入12项随机对照试验（2, 306例病例），meta分析结果显示与单药化疗相比双药化疗明显提高了老年晚期NSCLC患者的有效率（OR=1.80, 95%CI: 1.50-2.17, P < 0.000, 1）和1年生存率（OR=1.45, 95%CI:1.22-1.72, P < 0.000, 1）；含铂双药（OR=1.55, 95%CI:1.18-2.03, P=0.001）和非铂双药组（OR=1.38, 95%CI: 1.10-1.73, P=0.006）的1年生存率均明显高于单药组；含铂双药组更易发生3/4级贫血、中性粒细胞减少、血小板减少和神经毒性（P < 0.05），非铂双药组毒副反应发生率与单药组相似。
结论: 与单药组相比，双药组可明显提高化疗有效率和生存率，更适合作为老年晚期NSCLC一线化疗方案，但尚需开展针对老年患者的随机对照试验加以验证。