Objective To assess the clinical efficacy and safety of paclitaxel in the first-line and second-line treatment of patients with small cell lung cancer (SCLC).
Methods We searched The Cochrane Library, MEDLINE, EMBASE, CBM, CNKI, VIP and etc to collect all clinical controlled trials involving the addition of paclitaxel to chemotherapy in SCLC patients. Two reviewers evaluated the quality of included trials independently. The Cochrane Collaboration’s software RevMan 4.2.2 was used for meta-analyses.
Results Nine trials involving 1675 SCLC patients were included. Five trials were randomized controlled trials, and all trails didn’t mention the blinding methods. Meta analyses indicated that the PET arm (paclitaxel+cisplatin+etoposide) had a similar response rate compared with the EP arm (etoposide+cisplatin) (OR1.35, 95%CI 0.98 to 1.85). The incidences of severe thrombocytopenia (OR 1.68, 95%CI 1.12 to 2.52) and lethal toxicity (OR 4.00, 95%CI 1.77 to 9.04) were higher in the PET arm than those in the EP arm, but the incidence of severe leukocytopenia was lower in the PET arm (OR 0.50, 95%CI 0.37 to 0.68). A total of 54 treatment-related deaths were reported.
Conclusion In the first-line treatment of SCLC, the combination of paclitaxel, carboplatin and etoposide improved the progression-free survival, but the combination of paclitaxel and EP did not improve the survival and was more toxic than EP alone. Paclitaxel as the second-line treatment showed some therapeutic effect. Due to the poor quality and small sample size of included trials, more well-designed multi-center randomized controlled trials should be performed.
Citation： LI Ran,WANG Rui,TANG Jianhua,LUO Qi,AN Maomao,CAI Yun,LIANG Beibei,ZHANG Guiyun,LONG Liyan,CHEN Liangan. Paclitaxel for Small Cell Lung Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(10): 851-860. doi: 10.7507/1672-2531.20080190 Copy