Summary of findings 2. Non‐platinum therapies compared with platinum combination for non‐small cell lung cancer in the elderly population.
| Non‐platinum therapies compared with platinum combination for non‐small cell lung cancer in the elderly population | ||||||
| Patient or population: non‐small cell lung cancer in the elderly population Setting: first‐line chemotherapy for advanced non‐small cell lung cancer in elderly patients Intervention: platinum combination Comparison: non‐platinum therapies | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Numberof participants (studies) | Quality of evidence (GRADE) | Comments | |
| Risk with non‐platinum therapies | Risk with platinum combination | |||||
| Overall survival | Study population | HR 0.76 (0.69‐0.85) | (13 RCTs) | ⨁⨁⨁◯ Moderatea | ||
| Not applicable | Not applicable | |||||
| 1‐Year survival rate | Study population | RR 0.89 (0.82‐0.96) | 813 (13 RCTs) | ⨁⨁⨁◯ Moderatea | ||
| 714 per 1000 | 635 per 1000 (585‐685) | |||||
| Moderate | ||||||
| 667 per 1000 | 593 per 1000 (547‐640) | |||||
| Progression‐free survival | Study population | HR 0.76 (0.61‐0.93) | (9 RCTs) | ⨁⨁◯◯ Lowa,b,c | ||
| Not applicable | Not applicable | |||||
| Objective response rate (ORR) | Study population | RR 1.57 (1.32‐1.85) | 1432 (11 RCTs) | ⨁⨁⨁◯ Moderatea,b | ||
| 218 per 1000 | 342 per 1000 (288‐403) | |||||
| Moderate | ||||||
| 246 per 1000 | 386 per 1000 (325‐455) | |||||
| Grade 3 or higher hematological toxicity for platinum therapies ‐ anemia | Study population | RR 2.53 (1.70‐3.76) | 1437 (11 RCTs) | ⨁⨁◯◯ Lowa,b,d | ||
| 41 per 1000 | 105 per 1000 (70‐156) | |||||
| Moderate | ||||||
| 26 per 1000 | 65 per 1000 (44‐96) | |||||
| Grade 3 or higher hematological toxicity for platinum therapies ‐ thrombocytopenia | Study population | RR 3.59 (2.22‐5.82) | 1260 (9 RCTs) | ⨁⨁◯◯ Lowa,b,d | ||
| 28 per 1000 | 101 per 1000 (63‐164) | |||||
| Moderate | ||||||
| 26 per 1000 | 92 per 1000 (57‐149) | |||||
| Grade 3 or higher Non‐Hematological Toxicity for Platinum‐based therapies ‐ Peripheral neuropathy | Study population | RR 7.02 (2.42‐20.41) | 776 (5 RCTs) | ⨁⨁◯◯ Lowa,b,d | ||
| 5 per 1000 | 36 per 1000 (12‐104) | |||||
| Quality of life (QoL) | Only 5 RCTs assessed quality of life; however, we were not able to perform a meta‐analysis because of the paucity of available data | ‐ | (5 studies) | |||
| *Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: We are very confident that the true effect lies close to the estimate of effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
aWe downgraded the quality of evidence by one level because of serious risk of bias due to inclusion of unplanned elderly subgroup analysis.
bWe downgraded the quality of evidence by one level because of serious risk of bias. A large number of trials were open‐label. We considered absence of blinding as introducing potential risk for PFS, ORR, and adverse events.
cWe downgraded the quality of evidence by one level because of serious inconsistency (I2 = 63%; P value = 0.005). We explored reasons for heterogeneity by performing a subgroup analysis by type of non‐platinum therapy, type of platinum therapy, and trial design. We found heterogeneity only in the subgroup on the non‐platinum control arm (I2 = 79%); on the carboplatin‐based combination (I2 = 85%), and on elderly‐specific trials (I2 = 85%).
dWe downgraded the quality of evidence by one level because of serious imprecision (few events and wide confidence interval observed).