The role of vandetanib in the second-line treatment for advanced non-small-cell-lung cancer: a meta-analysis of four randomized controlled trials.

Abstract

BACKGROUND:

The purpose of this study was to assess the efficacy and toxicity of vandetanib in the second-line treatment for advanced non-small cell lung cancer (NSCLC).

METHODS:

We systematically searched for randomized clinical trials that compared therapy with vandetanib versus standard second-line treatment, including docetaxel, pemetrexed, erlotinib, or gefitinib, as second-line treatment for patients with histologically proven non-small-cell lung cancer. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival, overall response rate, and grade 3 or 4 toxicity. Data were extracted from the studies by two independent reviewers. The meta-analysis was performed by Stata version 10.0 software (Stata Corporation, College Station, TX, USA).

RESULTS:

Four randomized clinical trials (N = 3,292 patients) were eligible. Meta-analysis showed that there was significant improvement in PFS (hazards ration (HR), 0.91; 95% confidence interval (CI), 0.83-1.00; P = 0.039) and overall response rate (relative risk (RR), 1.49; 95% CI, 1.04-2.14; P = 0.03) in therapy with vandetanib group compared with standard second-line therapy group, although the pooled HR for overall survival (HR, 0.95; 95% CI, 0.88-1.03; P = 0.191) showed no significant difference between the two groups. In addition, there were less incidences of grade 3 or 4 anemia (RR, 0.39; 95% CI, 0.22-0.67; P = 0.001) in therapy with vandetanib group. With regard to the risk of grade 3 or 4 neutropenia (RR, 1.19; 95% CI, 1.0-1.43; P = 0.054), diarrhea (RR, 1.38; 95% CI, 1.0-1.94; P = 0.059), nausea and vomiting (RR, 0.77; 95% CI, 0.48-1.26; P = 0.308), rash (RR, 2.83; 95% CI, 0.73-10.9; P = 0.131), cough (RR, 1.19; 95% CI, 1.0-1.43; P = 0.054), and fatigue (RR, 1.0; 95% CI, 0.747-1.35; P = 0.971), there was no significant difference between the two groups.

CONCLUSIONS:

Therapy with vandetanib offered a clinically meaningful and statistically significant improvement in PFS and ORR in patients with advanced NSCLC but did not benefit overall survival. Therapy with vandetanib regimens might be suggested as second-line treatment for advanced NSCLC based on a similar toxicity profile compared with standard second-line therapy.

• Authors: Wei-Xiang Qi, Li-Na Tang, Ai-Na He, Zan Shen, Yang Yao
• Journal: Lung (Lung) Vol. 189 Issue 6 Pg. 437-43 (Dec 2011) ISSN: 1432-1750 [Electronic] United States
• PMID: 21986852 (Publication Type: Journal Article, Meta-Analysis)

Chemical References

• Antineoplastic Agents
• Piperidines
• Quinazolines
• vandetanib

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (adverse effects, therapeutic use)
• Carcinoma, Non-Small-Cell Lung (drug therapy, mortality)
• Humans
• Lung Neoplasms (drug therapy, mortality)
• Middle Aged
• Piperidines (adverse effects, therapeutic use)
• Quinazolines (adverse effects, therapeutic use)
• Randomized Controlled Trials as Topic
• Survival Rate
• Treatment Outcome