Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore.
J Thorac Oncol. 2011 Jun;6(6):1030-8. doi: 10.1097/JTO.0b013e3182199c03.
Although interethnic differences in survival to cytotoxic chemotherapy in patients with non-small cell lung cancer exist, an analysis of survival outcomes based on ethnicity has not yet been fully evaluated systematically using large patient cohorts. Furthermore, recent trial results may be confounded by the use of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI).
A meta-analysis was performed using trials identified through MEDLINE. Summary data on median overall survival (OS), time to progression, progression-free survival, and overall response rate (ORR) were collected from randomized controlled trials. Outcomes were compared between Asian and Caucasian studies.
Of the 1182 citations identified, 391 treatment arms (Asian 90 and Caucasian 301) were analyzed. The median OS and ORR in Asian and Caucasian studies for all chemotherapy regimens was 10.1 and 8.0 months (p < 0.001) and 32.2 and 25.9% (p < 0.001), respectively. The median OS in Asian and Caucasian studies for monotherapy, platinum doublets, and three drugs or more combination was 9.9 and 6.8 months, 10.4 and 8.6 months, and 9.4 and 8.0 months, respectively (all p < 0.001). In studies published pre-EGFR TKI, the median OS and ORR in Asian and Caucasian studies for all chemotherapy regimens was 9.1 versus 7.3 months (p < 0.001), respectively, and 29.0 and 23.0% (p < 0.006), respectively. The median OS in Asian and Caucasian studies for monotherapy, platinum doublets, and three drugs or more combination pre-EGFR TKI was 8.9 and 6.5 months (p < 0.005), 9.1 and 7.5 months (p < 0.001), and 9.3 and 7.6 months (p < 0.003), respectively. In third-generation platinum doublets, the median OS in Asian and Caucasian studies was 11.3 and 9.5 months (p < 0.001), respectively, and ORR was 35.0 and 29.8% (p < 0.001), respectively.
Ethnic differences in survival and response rate to chemotherapy exist and should be considered in clinical trial designs especially in the global context.
尽管非小细胞肺癌患者接受细胞毒性化疗的生存存在种族间差异，但尚未使用大型患者队列系统地分析基于种族的生存结果。此外，最近的试验结果可能因表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）的使用而受到干扰。
通过 MEDLINE 进行荟萃分析。从中收集随机对照试验的中位总生存期（OS）、无进展生存期、进展时间和总缓解率（ORR）的汇总数据。比较亚洲和高加索研究之间的结果。
在确定的 1182 篇引用中，分析了 391 个治疗臂（亚洲 90 个和高加索 301 个）。对于所有化疗方案，亚洲和高加索研究的中位 OS 和 ORR 分别为 10.1 个月和 8.0 个月（p < 0.001）和 32.2%和 25.9%（p < 0.001）。对于单药治疗、铂类双药治疗和三药或更多联合治疗，亚洲和高加索研究的中位 OS 分别为 9.9 个月和 6.8 个月、10.4 个月和 8.6 个月以及 9.4 个月和 8.0 个月（均 p < 0.001）。在 EGFR TKI 发表之前的研究中，对于所有化疗方案，亚洲和高加索研究的中位 OS 和 ORR 分别为 9.1 个月对 7.3 个月（p < 0.001）和 29.0%对 23.0%（p < 0.006）。对于单药治疗、铂类双药治疗和 EGFR TKI 之前的三药或更多联合治疗，亚洲和高加索研究的中位 OS 分别为 8.9 个月和 6.5 个月（p < 0.005）、9.1 个月和 7.5 个月（p < 0.001）和 9.3 个月和 7.6 个月（p < 0.003）。在第三代铂类双药治疗中，亚洲和高加索研究的中位 OS 分别为 11.3 个月和 9.5 个月（p < 0.001），ORR 分别为 35.0%和 29.8%（p < 0.001）。
生存和化疗反应率存在种族差异，在临床试验设计中应考虑这些差异，尤其是在全球范围内。
