Fixed-dose rate infusion and standard rate infusion of gemcitabine in patients with advanced non-small-cell lung cancer: a meta-analysis of six trials

• Published in: Cancer chemotherapy and pharmacology 2012-12, Vol.70 (6), p.861-873
• Main Authors: Qiu, Man-Tang, Ding, Xiang-Xiang, Hu, Jing-Wen, Tian, Hong-Ya, Yin, Rong, Xu, Lin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - adverse effects; Antineoplastic agents; Biological and medical sciences; Cancer Research; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Deoxycytidine - administration & dosage; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Drug Administration Schedule; Female; Humans; Infusions, Intravenous; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pneumology; Randomized Controlled Trials as Topic; Treatment Outcome; Tumors of the respiratory system and mediastinum
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-012-1974-z

Purpose To compare the response, survival, hematological and non-hematological toxicities of gemcitabine administrated at fixed-dose rate infusion (10 mg/m 2 /min, FDR) and standard 30 min infusion in patients with advanced non-small-cell lung cancer (NSCLC). Methods Electronic databases of MEDLINE, EMBASE and Cochrane Library were searched using key words of “gemcitabine,” “fixed-dose rate,” “non-small-cell lung cancer” and their alternative spellings. An expanded search of references of relative articles was also performed. The last search was performed on September 10, 2012. Primary endpoints were overall survival rate (ORR) and 1-year survival rate (1-year SR); hematological and non-hematological toxicities were secondary endpoints. Results Six randomized controlled trials, involving 867 patients, met our inclusion criteria and were analyzed. Pooled results showed that FDR infusion of gemcitabine had an equal ORR (RR = 0.91, 95 % CI: 0.74–1.13; heterogeneity p  = 0.39) and 1-year SR (RR = 1.09, 95 % CI: 0.93–1.29; heterogeneity p  = 0.75) compared with standard infusion. Subgroup analysis found that chemotherapy drug combinations do not affect the results of ORR or 1-year SR. Patients received FDR infusion, however, experienced more grade 3/4 hematological (neutropenia, leukopenia and anemia) and non-hematological (diarrhea and fatigue) toxicities. Conclusion This meta-analysis found that FDR infusion of gemcitabine had equal ORR and 1-year SR with standard infusion in patients with advanced NSCLC, while FDR infusion was associated with more grade 3/4 hematological and non-hematological toxicities.