Bone-targeted Therapy Use in Patients with Bone Metastases from Lung Cancer: A Systematic Review of Randomized Controlled Trials
A partir d'une revue systématique des essais randomisés publiés jusqu'en mai 2015 (13 études, 1 903 patients), cette étude analyse l'efficacité, du point de vue de la survie globale, de la survie sans progression, de la survenue d'événements indésirables liés au squelette et de la qualité de vie, d'agents thérapeutiques ciblant l'os dans la prise en charge des patients atteints d'un cancer du poumon et présentant des métastases osseuses
Highlights : •Bone-targeted agents (BTAs) are infrequently used in metastatic lung cancer. •BTAs are effective at delaying the annual incidence of SREs and time to first SRE. •Quality of life is a rare endpoint in studies looking at bone-targeting agents. •Adverse events with bone-targeting agents remain low and similar between agents. Background : Patients with advanced lung cancer commonly have bone metastases. Compared with other malignancies, the use of bone-targeted agents (e.g. bisphosphonates and denosumab) is less common in lung cancer patients. This may be due to the perception that bone-targeted agents are less effective in this population. Objective : To perform a systematic review to evaluate data from randomized trials of bone-targeted agents in lung cancer patients with bone metastases. Methods : A systematic search of Medline, Embase and the Cochrane Register of Controlled Trials through May 2015 was performed. Randomized trials of bone-targeted therapies in lung cancer patients with bone metastases were sought. Outcomes studied included skeletal related events (SREs), pain, quality of life, progression-free survival and overall survival. Random effects meta-analyses were planned if studies were judged homogeneous. Results : Of 632 abstracts, 17 publications describing 13 studies were included. Sample sizes ranged between 50-1776. Of 3,379 patients, 1,903 had lung cancer, with subgroup data available for 8 of 13 studies. Patient demographics were comparable, but enrollment criteria and endpoints were heterogeneous across studies, precluding meta-analysis. Study-specific results suggested that bone-modifying agents reduce the incidence of SREs and bone pain in lung cancer patients. Three studies suggested a survival benefit. Conclusion : Data from included trials suggests benefit of bone-targeted agents in lung cancer for the prevention of SREs and bone pain. There is a trend toward improvement in overall survival and progression-free survival, although further research is needed. Impact on quality of life and key subgroups for benefit both require future research.