A Cochrane review [Abstract] 1 [withdrawn from publication] included 65 studies with a total of 13 601 subjects. In the trials comparing a doublet regimen with a single-agent regimen, a significant increase was observed in tumor response (OR 0.42, 95% confidence interval [CI] 0.37 to 0.47) and one-year survival (OR 0.80, 95% CI 0.70 to 0.91) in favor of the doublet regimen. The median survival ratio was 0.83 (95% CI 0.79 to 0.89). An increase also was observed in the tumor response rate (OR 0.66, 95% CI 0.58 to 0.75) in favor of the triplet regimen, but not for one-year survival (OR 1.01, 95% CI 0.85 to 1.21). The median survival ratio was 1.00 (95% CI 0.94 to 1.06).
A systematic review of combination versus single agent chemotherapy 2 covering 25 studies and a total of 5156 subjects was abstracted in DARE. Combination chemotherapy produced a 2-fold increase in response rate compared to single-agent chemotherapy (RR 1.93, 95% CI 1.54 to 2.42) but also increased the risk of dying because of toxicity (RR 3.7, 95% CI 2.2 to 6.4). Survival at 6 months (RR 1.10, 95% CI 1.02 to 1.19) and at 12 months (RR 1.22, 95% CI 1.03 to 1.45) was greater with combination chemotherapy. In the subgroup analysis of platinum analogue or vinorelbine compared with patinum analogue or vinorelbine-based combination chemotherapy survival did not differ significantly at 6 months (RR 1.03) or at 12 months (RR 1.10, 95% CI 0.94 to 1.43).
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