Pooled analysis of the clinical benefit of cyclooxygenase-2 inhibitors combined with chemotherapy in advanced non-small cell lung cancer

Wei Zheng, Zhi-Min Liao, Yan Fu, Ya-Peng Wu, Qiong Zhang


Background: The purpose of this study was to perform a systematic review of the interventions for advanced non-small cell lung cancer (NSCLC) including chemotherapy alone and chemotherapy plus COX-2 inhibitors to identify and discuss the cause of any variation across studies and to explore the best currently available evidence.
Methods: The literature was comprehensively searched to identify relevant meta-analyses, and the Jadad decision algorithm was used to select the best evidence from the included meta-analyses. Quality assessment of the meta-analyses was performed using the Quality of Reporting (QUOROM) checklist and the Oxman-Guyatt quality index.
Results: Five meta-analyses were selected for inclusion in this study. Three were published prior to 2018 and had Oxman-Guyatt scores of 5. Only one study had the highest QUOROM and Oxman-Guyatt scores, and that study concluded that first-line treatment with chemotherapy plus COX-2 inhibitors was superior to chemotherapy alone in terms of the overall response rate (ORR). However, no significant difference in clinical benefit, progression-free survival (PFS), overall survival (OS), or 1-year survival rate was found. In addition, toxicities of the drugs had some influence on patients with heart disease.
Conclusions: The Jadad algorithm identified the optimal current meta-analysis. COX-2 inhibitors increased the ORR when combined with chemotherapy, but did not improve the survival indices. In addition, they may increase the risk of cardiovascular events and hematological toxicities in NSCLC patients.