Objective To evaluate the efficacy of Gefitinib for patients with non-small-cell lung cancer (NSCLC). Methods We searched several databases, including MEDLINE (1991 to June 2008), The Cochrane Library (Issue 4, 2008) and CBMDisc (1978 to Feb. 2008). Randomized controlled trials (RCTs) were included in the meta-analyses, which were done using The Cochrane Collaboration’s RevMan 4.2 software. We also included retrospective case reports published in Chinese journals. Results Eight RCTs and 36 uncontrolled case reports were analyzed. The results of the RCTs showed that 250 mg/d Gefitinib had similar efficacy to 500 mg/d, but the side effect was significantly less for the lower dose. When used as a combined first-line treatment or a third-line treatment, Gefitinib was not superior to placebo on response rate, survival rate and life span. When used as second-line treatment, it did not prolong median survival, though it gave a higher response rate than placebo. Gefitinib caused many more side effects than placebo. Gefitinib exhibited similar efficacy to docetaxel in objective response rate [OR 1.18, 95%CI (0.84, 1.67), P=0.35], but was better for symptom and quality-of-life improvement [OR 1.58, 95%CI (1.33, 1.89), Plt;0.00001]. The overall uncontrolled clinical studies showed the following results: complete response rate was 2.2%, partial response rate was 25.8%, disease stable rate was 40.0% and progressive disease rate was 32.0%. The average median survival time was 8.9 months; the average time to progressive disease was 5.2 months, and the 1-year survival rate was 44.2%. The average median survival from EAP studies (6.9 months) was shorter than that for all the studies as well as the registered clinical trials (10.0 months). The average periods to progressive disease for registered clinical trials (3.2 months) and EAP studies (4.4 months) were somewhat shorter than that found for all studies combined, though response rate and 1-year survival rate were similar. Since there was no controlled clinical study, it was hard to conclude from the results whether Gefitinib brought any clinical benefit to NSCLC patients in China. Conclusion Gifitinib is not suitable as a combined first-line treatment or a third-line treatment for NSCLC. The clinical favor from gefitinib in the second-line treatment remains uncertain. There is not enough evidence to show whether Chinese people are more sensitive to Gefitinib, and its use in the second-line treatment of NSCLC needs to be tested further.
Objective To assess the efficacy, safety and dosage regimen of docetaxel in patients with non small cell lung cancer (NSCLC). Methods We searched The Cochrane Library, MEDLINE, EMBASE, CBM, CNKI, VIP and etc to collect controlled trials which involved docetaxel as the second-line treatment of NSCLC. Two reviewers evaluated the quality of included trials independently. The Cochrane Collaboration’s software RevMan 4.2 was used for meta-analyses. Results Eight randomized controlled trials were included, all of which didn’t mention the blinding methods. Compared with best supportive care (BSC), the docetaxel group showed longer time to progression (10.6 vs. 6.7 weeks, Plt;0.001) and longer median survival (7.0 vs. 4.6 months, P=0.047), as well as greater 1-year survival (37% vs. 11%, P=0.003). Patients treated with docetaxel showed higher incidence of hematologic toxicity than those treated with BSC. Meta-analyses of different docetaxel dosage regimens (1-week vs. 3-week) showed that there were no statistical differences in terms of disease control rate, response rate or 1-year survival; but the incidence of hematologic toxicity of 1-week regimen was lower than that of 3-week regimen, and no statistical difference was noted in the incidence of non-hematologic toxicity between the two regimens. Conclusion Docetaxel as the second-line chemotherapy for NSCLC significantly improved survival compared with BSC. Two dosage regimens of docetaxel had no difference in efficacy, but some differences in hematologic toxicity. Thus, if serious hematologic toxicity occurs, the 3-week treatment regimen of docetaxel could be replaced by 1-week treatment regimen.
Objective To explore the effect of controlled release of nerve growth factor (NGF) on peripheral nerve defect repaire by acellular nerve graft. Methods The microspheres of NGF were prepared with drug microsphere technologyand fixed with the fibrin glue to make the compl icated controlled release NGF. Twenty healthy male SD rats weighing 280-300 g were adopted to prepare acellular xenogenous nerve, 52 male Wistar rats weighing 250-300 g were adopted to prepare the 10 mm defect model of left sciatic nerve. and thereafter were randomly divided into 4 groups: autograft group(group A), acellular nerve allograft combined with the double controlled release NGF (group B), acellular nerve allograft (group C) and acellular nerve allograft combined with fibrin glue (group D). Without any operation, the right sciatic nerve was regarded as control group. General observation was conducted after operation. The nerve axon regeneration length was measured 2 weeks after operation. The effects of peripheral nerve regeneration were evaluated by neural electrophysiology, the recovery rate of triceps surae muscular tension and weight and histological assessment 16 weeks after operation. Results All the animals survived till the end of experiment. The length of nerve regeneration was measured at 2 weeks after transplantation. The regeneration nerve of group A was longer than that of other groups (P lt; 0.05), group B longer than groups C and D (P lt; 0.05), and there were no difference between group C and group D (P gt; 0.05). At 16 weeks after operation, the recovery rates of nerve conduction velocity of groups A and B (73.37% ± 7.82% and 70.39% ± 8.45%) were larger than that of groups C and D (53.51% ± 6.31% and 55.28% ± 5.37%) (P lt; 0.05). The recovery rates of the triceps surae muscular tension in group A (85.33% ± 5.59%) were larger than that in groups B, C and D (69.79% ± 5.31%, 64.46% ± 8.49％ and 63.35% ± 6.40%) (P lt; 0.05). There were no significant differences among groups B, C and D (P gt; 0.05). The recovery rates of the triceps surae weight in group A (62.54% ± 8.25%) werelarger than that in groups B, C and D (53.73% ± 4.56%, 46.37% ± 5.68% and 45.78% ± 7.14%, P lt; 0.05). There was significant difference between group B and groups C, D (P lt; 0.05) and no significant differences between group C and group D (P gt; 0.05). The histological observation indicated that axon number and myel in thickness in group B were larger than those in group C and group D (P lt; 0.05). The axonal diameter in group B was significantly less than that in group A (P lt; 0.05). Conclusion Acellular nerve graft combined with the controlled release NGF is a satisfactory alternative to repair the peripheral nerve defect.