Non-platinum regimens of gemcitabine plus docetaxel versus platinum-based regimens in first-line treatment of advanced non-small cell lung cancer: a meta-analysis on 9 randomized controlled trials.

PURPOSE: The aim was to compare the efficacy and toxicity of gemcitabine plus docetaxel (GD) with platinum-based regimens in patients with untreated advanced non-small cell lung cancer (NSCLC).

METHODS: We searched PubMed, Embase and the Cochrane Central Register of Controlled Trials databases for relevant trials. Reference lists of original articles and review articles were also examined. Abstracts presented at the ASCO and ESMO meetings were also searched. Studies were evaluated for eligibility and quality, and then, the data were extracted and analyzed. Statistical analyses were conducted by using RevMan 5.1. The primary end point was overall survival (OS). Secondary end points included 1-year survival, time to progression (TTP), overall response rate (ORR) and grade 3–4 toxicity.

RESULTS: Nine randomized controlled trials were identified ultimately. The meta-analysis demonstrated that the survival between GD and platinum-based regimens was comparable according to the pooled HR for overall survival (1.04, 95% CI = 0.96–1.12, p = 0.39) and RR for one-year survival (0.94, 95% CI = 0.84–1.06, p = 0.33). Platinum-based regimens had an advantage in TTP (HR = 1.12, 95% CI = 1.02–1.24, p = 0.02) and ORR (RR = 0.86, 95% CI = 0.74–0.99, p = 0.03). However, GD induced less grade 3–4 nausea/vomiting, anemia, neutropenia and febrile neutropenia (RR = 0.36, 95% CI = 0.15–0.86, p = 0.02; RR = 0.35, 95% CI = 0.23–0.53, p = 0.00; RR = 0.68, 95% CI = 0.52–0.88, p = 0.003; RR = 0.53, 95% CI = 0.34–0.82, p = 0.004, respectively). Grade 3–4 diarrhea, sensory neuropathy, fatigue and thrombocytopenia were comparable between the two groups.

CONCLUSIONS: GD acquired similar survival with platinum-based regimens in first-line treatment of advanced NSCLC. Platinum-based regimens had an advantage in TTP and ORR with more grade 3–4 nausea/vomiting, anemia, neutropenia and febrile neutropenia compared with GD.