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What is the optimal management of potentially resectable stage III-N2 NSCLC? Results of a fixed-effects network meta-analysis and economic modelling.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Maconachie, Ross 
Mercer, Toby 

Abstract

INTRODUCTION: There is a critical need to understand the optimal treatment regimen in patients with potentially resectable stage III-N2 nonsmall cell lung cancer (NSCLC). METHODS: A systematic review of randomised controlled trials was carried out using a literature search including the CDSR, CENTRAL, DARE, HTA, EMBASE and MEDLINE bibliographic databases. Selected trials were used to perform a Bayesian fixed-effects network meta-analysis and economic modelling of treatment regimens relevant to current-day treatment options: chemotherapy plus surgery (CS), chemotherapy plus radiotherapy (CR) and chemoradiotherapy followed by surgery (CRS). FINDINGS: Six trials were prioritised for evidence synthesis. The fixed-effects network meta-analyses demonstrated an improvement in disease-free survival (DFS) for CRS versus CS and CRS versus CR of 0.34 years (95% CI 0.02-0.65) and 0.32 years (95% CI 0.05-0.58) respectively, over a 5-year period. No evidence of effect was observed in overall survival although point estimates favoured CRS. The probabilities that CRS had a greater mean survival time and greater probability of being alive than the reference treatment of CR at 5 years were 89% and 86% respectively. Survival outcomes for CR and CS were essentially equivalent. The economic model calculated that CRS and CS had incremental cost-effectiveness ratios of £19 000/quality-adjusted life-year (QALY) and £78 000/QALY compared to CR. The probability that CRS generated more QALYs than CR and CS was 94%. INTERPRETATION: CRS provides an extended time in a disease-free state leading to improved cost-effectiveness over CR and CS in potentially resectable stage III-N2 NSCLC.

Description

Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 3211 Oncology and Carcinogenesis, Health Disparities, Clinical Trials and Supportive Activities, Lung, Lung Cancer, Cancer, Cost Effectiveness Research, Comparative Effectiveness Research, Women's Health, Clinical Research, Cancer, 3 Good Health and Well Being

Journal Title

ERJ Open Res

Conference Name

Journal ISSN

2312-0541
2312-0541

Volume Title

9

Publisher

European Respiratory Society (ERS)