Lung cancer: preoperative chemotherapy, systematic review and IPD meta-analysis

Preoperative chemotherapy for non-small cell lung cancer: a systematic review and meta-analysis of individual participant data

Does giving chemotherapy before surgery (with or without radiotherapy) help patients with non-small cell lung cancer live longer?

What was this study about?

Non-small cell lung cancer is the most common type of lung cancer. If the tumour is not too big and has not spread to other parts of the body, doctors usually operate to remove it. At the same time, they may also remove a bit of the lung, or the entire lung that has the tumour. They may also give radiotherapy (treatment with x-rays) after the operation. Adding chemotherapy (drug treatment) before surgery and radiotherapy may be better. This treatment is sometimes called neoadjuvant or pre-operative chemotherapy

Despite many trials there has been uncertainty about the effectiveness of this treatment, therefore we did a systematic review and meta analysis of individual participant data. It brought together information from all patients who took part in similar trials. It included all trials, not just the reported ones. The study aimed to find out if giving chemotherapy before surgery (with or without radiotherapy) could:

Help patients live longer
Stop the cancer coming back (recurrence
Stop the cancer spreading to other parts of the body (metastases).

What difference did this study make?

This study found that people with non-small cell lung cancer that had chemotherapy before surgery (with or without radiotherapy) lived longer than those who has surgery (with or without radiotherapy).

After 5 years, 45 out of every 100 who were given chemotherapy before surgery were alive compared to 40 out of every 100 who had surgery.A chemotherapy was also shown to improve recurrence-free survival and distant recurrence.

The benefit of chemotherapy was seen regardless of the type of chemotherapy given or how the chemotherapy was given, the patients’ age, performance status, histology or disease stage.

Chemotherapy before surgery (with or without radiotherapy) should now be considered a valid treatment option for patients with operable non-small cell lung cancer.

NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet. 2014;383:1561-71

Type of study

Meta-analyses

Contact details

MRCCTU.Meta-Analysis@ucl.ac.uk

Who funded the study?

The Medical Research Council.

When did it take place?

This study was published in 2014 and brought together the results of trials that were carried out between 1985 and 2007.

Where did it take place?

The study was done at the MRC Clinical Trials Unit at UCL but it brings together the results of trials from all over the world.

Who was included?

The study brought together 15 trials and 2385 patients from all over the world.