Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.581
Peer-review started: July 15, 2020
First decision: September 29, 2020
Revised: October 17, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: January 26, 2021
The proportion of non-small cell lung cancer (NSCLC) is more than 80% of all lung tumors. Most patients have advanced NSCLC at stage ШB or IV when diagnosed and have to receive alleviative treatment in order to maintain their lives. The median survival time is 6-10 mo for patients who are diagnosed with advanced NSCLC in performance status 0-2 when adopting palliative first-line chemotherapy.
The motivation of this study is to investigate COX-2 for intervention of NSCLC, which is mired in controversy in the medical field.
This systematic review based on randomized controlled trials was conducted to appraise the benefit of chemotherapy-assisted addition of COX-2 for advanced NSCLC.
We searched the six electronic databases up until December 9, 2019 for studies that examined the efficacy and safety of the addition of COX-2 inhibitors to chemotherapy for NSCLC. Overall survival(OS), progression free survival (PFS), 1-year survival rate (SR), overall response rate (ORR), clinical benefit (CB), complete response (CR), partial response (PR), stable disease (SD), and toxicities were measured with more than one outcome as their endpoints. Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using Egger’s linear regression test. Data analysis was performed using R software.
The COX-2 inhibitors combined with chemotherapy were not found to be more effective than chemotherapy alone in OS, PFS, 1-year SR, CB, CR, and SD. However, there was a difference in ORR for patients with advanced NSCLC. In a subgroup analysis, significantly increased ORR results were found for celecoxib, rofecoxib, first-line treatment, and PR. For adverse events, the increase in COX-2 inhibitor was positively correlated with the increase in grade 3 and 4 toxicity of leukopenia, thrombocytopenia and cardiovascular events.
COX-2 inhibitor combined with chemotherapy increased total effective rate of advanced NSCLC with the possible increased risk of blood toxicity and cardiovascular events and had no effect on survival index.
This study can provide reference value for the application of COX-2 in the treatment of lung cancer.