Excerpt

Lung cancer is the leading cause of cancer death in both men and women in the United States, and male Veterans seeking care at VA hospitals have a much higher age-specific incidence of lung cancer than males in the general population. The personal and economic significance of lung cancer has led to a vast research endeavor to try and identify new and more effective treatments. Most patients with lung cancer are diagnosed when the cancer is already advanced (stage IIIB or IV), and they are no longer candidates for surgical resection. Small cell lung cancer and non-small cell lung cancer (NSCLC) are different diseases in terms of treatment. Until recently, all therapies for advanced NSCLC were based on their cytotoxic properties. In the last few years, several novel agents aimed at specific molecular targets have been developed. This review was requested to evaluate the current evidence on the effectiveness and cost-effectiveness of treatments for advanced lung cancer.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 For patients with metastatic non-small cell lung cancer (NSCLC) what is the comparative effectiveness of the different recommended (e.g. NCCN guidelines) first line chemotherapy regimens?
  • KEY QUESTION 2 For patients with metastatic NSCLC what is the comparative effectiveness of the different recommended (e.g. NCCN guidelines) second line chemotherapy regimens?
  • KEY QUESTION 3 For patients with metastatic NSCLC what is the benefit of maintenance therapy following first line chemotherapy regimens compared with no maintenance therapy?
  • KEY QUESTION 4 What is the relative cost and cost-effectiveness of the different approaches in Key Questions 1–3?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • SUMMARY
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY FOR SYSTEMATIC REVIEWS AND COST-EFFECTIVENES ANALYSES (SEARCH #1)
• APPENDIX B SEARCH STRATEGY FOR TRIALS (SEARCH #2)
• APPENDIX C SCREENER FORMS USED FOR SYSTEMATIC REVIEWS AND COST-EFFECTIVENES ANALYSES
• APPENDIX D PEER REVIEWER COMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Quality Enhancement Research Initiative, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, Paul G. Shekelle, M.D., Ph.D., Director.

Suggested citation:

Maher, AR, Miake-Lye, IM, Beroes, JM, Shekelle, PG. Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness. VA-ESP Project #05-226; 2012.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report