Critical appraisal:Früh M, Rolland E, Pignon JP, Seymour L, Ding K, Tribodet H, et al 2008

This appraisal has been completed.

Article

Früh M, Rolland E, Pignon JP, Seymour L, Ding K, Tribodet H, et al. Pooled analysis of the effect of age on adjuvant cisplatin-based chemotherapy for completely resected non-small-cell lung cancer. J Clin Oncol 2008 Jul 20;26(21):3573-81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18640938.

Assigned to

User:Michael.brown

Topic area

Guidelines:Lung cancer/Treatment/Non-small-cell stage III operable

Clinical question

• What is the clinical benefit of adjuvant chemotherapy for patients with stage III operable NSCLC?

Form

Form:Critical appraisal

Section below only relevant for Cancer Council Project Officer

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Critical Appraisal

Article being appraised

Früh M, Rolland E, Pignon JP, Seymour L, Ding K, Tribodet H, et al. Pooled analysis of the effect of age on adjuvant cisplatin-based chemotherapy for completely resected non-small-cell lung cancer. J Clin Oncol 2008 Jul 20;26(21):3573-81 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18640938.

Applicable clinical question

• What is the clinical benefit of adjuvant chemotherapy for patients with stage III operable NSCLC?

Key Facts

Study Design

systematic review — The LACE metaanalysis contains five large randomised controlled trials and is based on individual patient data.

Number of Patients:

1,247

Includes an economic evaluation

no

Evidence ratings

Level of evidence

I

Risk of bias

Low risk of bias

Comments: The quality of evidence in the LACE metaanalysis has been assessed elsewhere.

Size of effect

2

Reason for decision: Although there was no statistically significant interaction or test for trend between age and treatment effect for overall survival (OS), the hazard ratio (HR) for OS for the elderly was 0.87 (95% CI, 0.68 to 1.11). The authors of the metaanalysis did not mention any particular baseline clinical characteristics that might help to explain the widened confidence intervals for the elderly group. A significantly higher proportion of elderly patients died a non-lung cancer death although there no significant interaction between age and lung cancer or non-lung cancer deaths was observed. In addition, it was observed that significantly more elderly patients had a performance status (PS)>0. Elderly patients also received significantly less cisplatin in the first dose and in total amount. However, there were no significant differences among age groups in overall or specific toxicity rates or in treatment-related deaths. Therefore, possible interpretations of these data to explain omissions and/or reductions in chemotherapy dose include (i) elderly patients tolerated mild toxicities less well or (ii) study physicians more often applied risk avoidance measures in elderly patients.

Relevance of evidence

1

Additional comments: By interaction test and test for the trend, the survival benefit conferred by adjuvant chemotherapy on elderly patients (>70 years of age) was not significantly different from that conferred on younger patients. No significant difference according to age category was observed for stage but with only 93 of the 1,247 patients with stage 3 disease defined as elderly, it is difficult to determine the extent of benefit specifically conferred by adjuvant chemotherapy in this patient subgroup.

Result of appraisal

Included

Completed by

Professor Michael Brown MBBS PhD FRACP FRCPA