Maintenance or Consolidation Therapy for Non--Small-Cell Lung Cancer: A Meta-Analysis Involving 5841 Subjects

Introduction: Maintenance therapy is a new treatment paradigm for advanced non-small-cell lung cancer (NSCLC). We conducted a meta-analysis to evaluate its clinical efficacy in NSCLC and compared the efficacy of chemotherapy, epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), and other treatment approaches.

Materials and methods: Electronic databases were obtained from published reports of randomized controlled trials (RCTs) that compared maintenance or consolidation therapy with placebo, best supportive care (BSC) or just observation. Hazard ratios for progression-free survival (PFS) and overall survival (OS), with their relative 95% confidence intervals (CIs), were derived. All statistical analyses were conducted with RevMan 5.0 software, and statistical significance was defined as P < .05.

Results: A total of 14 RCTs involving 5841 patients were eligible for our analysis, including chemotherapy used in 5 RCTs, EGFR-TKI in 6, and others (eg, biotherapy) in 3. Our study showed that compared with the control, maintenance or consolidation therapy could prolong the OS (odds ratio [OR], 0.84; 95% CI, 0.75-0.95; P = .005) and PFS (OR, 0.63; 95% CI, 0.54-0.73; P < .00001) periods. Subgroup analysis showed that chemotherapy can improve PFS but not OS, EGFR-TKI can improve PFS and OS, and other therapies can improve neither PFS nor OS.

Conclusion: Our meta-analysis demonstrated that maintenance therapy for advanced NSCLC patients can decrease the PFS risk to 0.63 and OS to 0.84. However, its clinical effect has yet to be confirmed by further studies.