Comparison of irinotecan/carboplatin versus etoposide/carboplatin for extended disease small cell lung cancer (ED-SCLC): A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Platinum-based chemotherapy in addition to the non-platinum agent etoposide is the standard of care for extensive-stage small cell lung cancer (ES-SCLC). However, the front-line chemotherapy regimen is not known. Therefore, we aimed to perform this review comparing irinotecan/carboplatin (IC) and etoposide/carboplatin (EC) in patients of extended disease small cell lung cancer (ED-SCLC).

Methods: We searched three databases, that is, PubMed, Embase, and Cochrane Library. The outcomes for complete response (CR), median overall survival (OS), and progression-free survival (PFS) were evaluated. In addition, adverse events such as leukopenia, thrombocytopenia, anemia, diarrhea, and infections were also assessed. RevMan 5.4.1 was used to perform the statistical analysis.

Results: Three randomized controlled trials (RCTs) with 676 patients were included. There was a significant difference between IC and EC arms in terms of CR (risk ratio [RR] = 2.52; 95% confidence interval [CI]: 1.20–5.32; p = 0.02, I² (i.e., the percentage of the total variance that is due to between-study heterogeneity) = 0%), leukopenia (RR = 0.47; 95% CI: 0.23–0.97; p = 0.04; I² = 90%), amimia (RR = 0.55; 95% CI: 0.38–0.78; p = 0.0008; I² = 0%), thrombocytopenia (RR = 0.51; 95% CI: 0.39–0.68; p = 0.00001; I² = 0%), and diarrhea (RR = 4.88; 95% CI: 1.64–14.49; p = 0.004; I² = 33%). There was no statistically significant difference between IC and EC arms in terms of median OS (hazard ratio [HR] = 1.16; 95% CI: 0.84–1.62; p = 0.37; I² = 74%), PFS (HR = 1.04; 95% CI: 0.69–1.56; p = 0.85; I² = 77%), nausea (RR = 1.70; 95% CI: 0.76–3.81; p = 0.19; I² = 0%), infection (RR = 0.97; 95% CI: 0.64–1.48; p = 0.89; I² = 0%), and treatment-related deaths (RR = 0.58; 95% CI: 0.24–1.42; p = 0.23; I² = 0%).

Conclusion: This meta-analysis provides valuable evidence supporting the superiority of IC regimens over EC regimens in terms of CR and toxicity profile for ED-SCLC.

Keywords

carboplatin / ED-SCLC / etoposide / irinotecan / small cell lung cancer

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