Efficacy and safety of docetaxel for advanced non-small-cell lung cancer: A meta-analysis of Phase III randomized controlled trials
the ONA take:
Docetaxel is safer and more effective than vinca alkaloids, such as vinorelbine, as first-line therapy for patients with advanced non-small cell lung cancer (NSCLC), and causes less toxicity than vinca alkaloids when used as second-line therapy, according to a meta-analysis published in the journal OncoTargets and Therapy.
For the study, researchers at Sichuan University in Chengdu, China, sought to compare the efficacy and safety of docetaxel with pemetrexed or a vinca alkaloid for NSCLC by conducting a meta-analysis of phase 3 randomized controlled trials. Researchers identified 7 eligible trials that included 2,080 patients.
Results showed that docetaxel improved progression-free survival and overall response rate compared with a vinca alkaloid as first-line therapy for NSCLC. There was no difference in efficacy between docetaxel and pemetrexed as both first- and second-line treatment.
In regard to safety, the analysis demonstrated a higher risk of grade 3 or 4 neutropenia and febrile neutropenia with docetaxel compared with pemetrexed, but a lower rate of anemia when used as first-line treatment. There was no difference in the rate of non-hematologic toxicity between docetaxel and pemetrexed. When compared with a vinca alkaloid, docetaxel treatment resulted in less grade 3 or 4 hematological and non-hematological toxicity.
Further research should focus on the differences in efficacy and safety between docetaxel and pemetrexed as first- and second-line treatment of patients with advanced NSCLC, as well as patient factors that may influence treatment outcomes.
OncoTargets and Therapy
Background: Several clinical trials have performed risk–benefit analyses comparing docetaxel and pemetrexed or docetaxel and vinca alkaloid, but the efficacy and safety remain uncertain. The aim was to conduct a meta-analysis to compare the efficacy and safety of docetaxel and pemetrexed or docetaxel and vinca alkaloid for non-small-cell lung cancer.
Methods: This meta-analysis of Phase III randomized controlled trials was performed after searching PubMed, Embase, the Cochrane Library, and the ISI Web of Knowledge for randomized controlled trials. Outcome analyses were overall survival, progression-free survival, and overall response rate with 95% confidence intervals and major grade 3/4 toxicity.
Results: Seven eligible trials involving 2,080 patients were retrieved for analysis. Docetaxel enhanced progression-free survival and overall response rate compared with vinca alkaloid as first-line treatment (P<0.05). However, there was no difference between docetaxel and pemetrexed as both first-line and second-line treatment (P>0.05). With regard to the grade 3/4 toxicity, compared with pemetrexed, docetaxel led to higher neutropenia and febrile neutropenia (P<0.05), but there was no difference in non-hematological toxicity (P>0.05). Docetaxel led to a lower rate of anemia as first-line treatment (P<0.05). Moreover, docetaxel caused less grade 3/4 hematological and non-hematological toxicity compared with vinca alkaloid.
Conclusion: Docetaxel leads to a better result than vinca alkaloid in effectiveness and safety on patients with advanced non-small-cell lung cancer as first-line therapy. Docetaxel also causes lower toxicity as second-line therapy compared with vinca alkaloid. However, the differences in efficacy and safety between docetaxel and pemetrexed are not obvious. Further clinical study with more details, such as sex, age, histology, and so on, should be considered for illustrating the differences between these two drugs.
Keywords: docetaxel, NSCLC, risk-benefit analysis, systematic review