Comparative Effectiveness, Safety of First-Line Chemotherapy Regimens in Advanced NSCLC

It may be time for clinicians to re-evaluate the use of anagrelide in patients with high-risk ET.
It may be time for clinicians to re-evaluate the use of anagrelide in patients with high-risk ET.
There are few observational studies examining patients with aNSCLC who have been treated with immune checkpoint inhibitor therapy.

According to results of a systematic literature review presented in a poster at the IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer, Barcelona, Spain, use of first-line chemotherapy doublets involving pemetrexed, nab-paclitaxel, or the addition of bevacizumab to platinum-based combination chemotherapy “trended toward” longer overall survival (OS) and progression-free survival (PFS) compared with older first-line platinum-based doublet therapy in patients with advanced non-small cell lung cancer (aNSCLC).

The aim of this study was to evaluate the relative effectiveness and safety of first-line treatment regimens for aNSCLC using recently published data (2012 to 2018) from observational studies to approximate a “real-world” setting.

Of the 18 studies or conference abstracts included in the systematic review, only 7 used methods to balance treatment arms with respect to patient characteristics. Data involving patients with disease characterized by genomic alterations in EGFR, ALK, and KRAS were excluded from the analysis. All of the identified studies involved comparisons of chemotherapy regimens, whereas no studies involving immune checkpoint inhibitor therapy were identified.

With a focus on those studies where patients in the different treatment arms had similar characteristics, improved OS was observed for patients who received bevacizumab in addition to carboplatin-paclitaxel compared with carboplatin-paclitaxel chemotherapy alone. No significant difference in OS was observed when patients receiving 2 different platinum-doublets were compared, when patients treated with a platinum-pemetrexed doublet were compared with those receiving carboplatin-paclitaxel, or in a comparison of the outcomes of patients treated with bevacizumab-carboplatin-paclitaxel versus a platinum-pemetrexed regimen.

With respect to PFS, there was a significant benefit for a platinum-pemetrexed regimen compared with carboplatin-paclitaxel, and for the addition of bevacizumab to carboplatin-paclitaxel.

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Interestingly, PFS was significantly improved for patients receiving a platinum-pemetrexed regimen compared with bevacizumab-carboplatin-paclitaxel, although the difference in OS for patients receiving these 2 regimens was not statistically significant.

Regarding safety, comparisons of the nonhematologic toxicities experienced by patients receiving the different chemotherapy regimens did not reveal significant differences in the incidences of nonhematologic adverse events, and only few differences with respect to hematologic toxicity.

In their concluding remarks, the study authors stated that these results were “broadly consistent with those observed in clinical trials” and commented that “comparative real-world evidence for immunotherapies in the first-line [treatment] of advanced NSCLC is lacking and is expected to emerge in the future.”


Korytowsky B, Goring S, Li TJJ, et al. Comparative effectiveness of first line (1L) therapies for advanced non-small cell lung cancer (aNSCLC): A systematic literature review (SLR). Presented at: IASLC 2019 World Conference on Lung Cancer (WCLC); September 7-10, 2019; Barcelona, Spain. Abstract P1.01-06.

This article originally appeared on Cancer Therapy Advisor