A related Comment article notes that although platinum-based chemotherapy represents the cornerstone of first-line treatment of advanced non-small-cell-lung cancer (NSCLC), the optimum duration of remains unclear.
The current meta-analysis is limited by the fact that the included studies were heterogeneous – in terms of the number of cycles (two compared 3 vs. 6 cycles and two compared 4 vs. 6) and the administered regimens. Therefore although the results show that a short duration of chemotherapy in the first-line setting might be sufficient for most patients with NSCLC, they should be interpreted with caution.
Further limitations are highlighted. For example in one of the included studies, patients were randomised after completion of the initial two cycles (thus eliminating chemotherapy-resistant patients, introducing selection bias), and over half subsequently went on to receive gefitinib (subsequent treatment lines can confound the effect of first-line chemotherapy on overall survival). In this analysis 6 cycles of chemotherapy was associated with a longer progression-free survival, and the authors note that this could be an acceptable endpoint under certain circumstances.
Overall the results of the analysis support the notion that the duration of first-line chemotherapy for NSCLC should be personalised for every individual patient, and the authors suggest that the identification and selection of those patients who might benefit more from less chemotherapy should include biological and genomic factors that probably affect the disease course.