Systematic review and meta-analysis of Endostar (rh-endostatin) combined with chemotherapy versus chemotherapy alone for treating advanced non-small cell lung cancer

Biaoxue Rong, Shuanying Yang, Wei Li, Wei Zhang, Zongjuan Ming, Biaoxue Rong, Shuanying Yang, Wei Li, Wei Zhang, Zongjuan Ming

Abstract

Background: Many studies have investigated the efficacy of Endostar combined with platinum-based doublet chemotherapy (PBDC) versus PBDC alone for treating advanced non-small cell lung cancer (NSCLC). This study is a meta-analysis of available evidence.

Methods: Fifteen studies reporting Endostar combined with PBDC versus PBDC alone for treating advanced NSCLC were reviewed. Pooled odds ratios and hazard ratio with 95% confidence intervals were calculated using either the fixed effects model or random effects model.

Results: The overall response rate (ORR) and disease control rate (DCR) of Endostar combined with PBDC for treating NSCLC were significantly higher than those of PBDC alone, with 14.7% and 13.5% improvement, respectively (P < 0.00001). In addition, the time to progression (TTP) and quality of life (QOL) were improved after the treatment of Endostar combined with PBDC (P < 0.00001). The main adverse effects found in this review were hematological reactions, hepatic toxicity, and nausea/vomiting. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone (P < 0.05).

Conclusions: Endostar combined with PBDC was associated with higher RR, DCR, and TTP as well as superior QOL profiles compared with PBDC alone. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone.

Figures

Figure 1
Figure 1
Flow chart of literature search. RCTs, randomized controlled trials.
Figure 2
Figure 2
ORR of Endostar combined with PBDC versus PBDC alone for treating NSCLC. GP, gemcitabine + cisplatin; NP, vinorelbine + cisplatin; OR, odds ratio; ORR, overall response rate; PBDC, platinum-based doublet chemotherapy; PP, paclitaxel + cisplatin; RT, radiotherapy; TC, paclitaxel + carboplatin; TP, docetaxel + cisplatin.
Figure 3
Figure 3
DCR of Endostar combined with PBDC versus PBDC alone for treating NSCLC. DCR, disease control rate; GP, gemcitabine + cisplatin; NP, vinorelbine + cisplatin; OR, odds ratio; PBDC, conventional platinum-based doublet chemotherapy; PP, paclitaxel + cisplatin; RT, radiotherapy; TC, paclitaxel + carboplatin; TP, docetaxel + cisplatin.
Figure 4
Figure 4
OYS and QOL improvement of Endostar combined with PBDC versus PBDC alone for treating NSCLC. HR, hazard ratio; OR, odds ratio; OYS, one-year survival rate; PBDC, conventional platinum-based doublet chemotherapy; QOL, quality of life.
Figure 5
Figure 5
TTP of Endostar combined with PBDC versus PBDC alone for treating NSCLC. PBDC, conventional platinum-based doublet chemotherapy; TTP, time to progression.
Figure 6
Figure 6
Meta-analysis of the severe leukopenia and thrombocytopenia between Endostar combined with PBDC and PBDC alone. OR, odds ratios; PBDC, conventional platinum-based doublet chemotherapy.
Figure 7
Figure 7
Meta-analysis of anemia and nausea/vomiting between Endostar combined with PBDC and PBDC alone. OR, odds ratios; PBDC, conventional platinum-based doublet chemotherapy.
Figure 8
Figure 8
Assessment of publication bias. (A) Funnel plot for the ORR of Endostar combined with PBDC versus PBDC alone; (B) Funnel plot for the DCR of Endostar combined with PBDC versus PBDC alone; (C) Begg’s publication bias plot for the ORR of Endostar combined with PBDC versus PBDC alone; (D) Egger’s publication bias plot for the ORR of Endostar combined with PBDC versus PBDC alone.

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