A Cochrane review[Abstract] 1 assessed sixteen RCTs including 2 714 patients with advanced non-small-cell lung cancer (NSCLC) not eligible for surgery or radiotherapy, comparing first line chemotherapy and supportive care versus supportive care alone. All studies were of good methodological quality.
Survival analyses showed a highly statistically significant benefit of chemotherapy on survival (HR = 0.77; 95% CI 0.71 to 0.83, P < 0.0001) translating to an absolute improvement of 9% at 12 months (from 20% to 29%) or an absolute increase in median survival of 1.5 months (from 4.5 months to six months). There was no clear evidence of a difference in the effect of chemotherapy between chemotherapy types (P = 0.63) or between combination chemotherapy and single-agent chemotherapy (P = 0.40). There also was no clear evidence of a difference or trend in the relative effect of chemotherapy in patient subgroups defined by age (P = 0.64), sex (P = 0.77), stage (P = 0.35), histology (P = 0.75) or performance status (P = 0.54). Evidence from trials that collected quality of life data also suggests that this approach is unlikely to be detrimental to the patient's quality of life.
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