Comparative survival with diverse chemotherapy regimens for cancer of unknown primary site: Multiple-treatments meta-analysis
Received 15 April 2009; received in revised form 19 May 2009; accepted 24 May 2009. published online 18 June 2009.
Summary
Objectives
To synthesize the evidence from randomized controlled trials concerning systemic treatment regimens for patients with cancer of unknown primary site (CUP).
Data sources
PubMed and the Cochrane Library Central Registry of Controlled Trials.
Review methods
We retrieved all randomized controlled trials comparing at least two arms of different systemic treatment regimens or a systemic regimen to no treatment in patients with CUP, excluding data on favorable subset CUP, whenever these could be separated. Treatments were categorized according to whether they involved platinum, taxane, both, or neither; non-platinum/non-taxane regimens were also categorized in monotherapy and combination regimens. We extracted or estimated the logarithm of the hazard ratio and its variance for death for each randomized comparison. Multiple-treatments meta-analysis with a hierarchical Bayesian model obtained summary hazard ratios with 95% credibility intervals.
Results
Ten articles were eligible for the meta-analysis. No trials compared systemic treatment to best supportive care and all arms referred to chemotherapy regimens. Overall 683 subjects were randomly assigned and eight randomized comparisons were used for the multiple-treatments meta-analysis of survival (543 patients). Multiple-treatments meta-analysis showed no significant benefit for any treatment group over others, with wide credibility intervals. Point estimates of hazard ratios favored platinum, taxane, or both (hazard ratios 0.69, 0.66, and 0.81, respectively, as compared with monotherapy with an agent other than platinum or taxane).
Conclusion
No type of chemotherapy has been solidly proven to prolong survival in patients with CUP. Regimens using either platinum or taxanes or both need further testing.
aDepartment of Medical Oncology/Digestive Oncology, Jules-Bordet Institute, Brussels, Belgium
bDivision of Medical Oncology, University of Ioannina, School of Medicine, Ioannina, Greece
cClinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina, School of Medicine, Ioannina, Greece
dMedical Oncology Clinic Sörmland, Mälarsjukhuset, Eskilstuna, Sweden
eDepartment of Medicine, Tufts University School of Medicine, Boston, MA, USA
Corresponding author. Address: Division of Medical Oncology, University of Ioannina School of Medicine, Niarchou Avenue, 45500 Ioannina, Greece. Tel.: +30 2651099394.
ABSTRACT