Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2021; 9(3): 581-601
Published online Jan 26, 2021. doi: 10.12998/wjcc.v9.i3.581
Clinical benefit of COX-2 inhibitors in the adjuvant chemotherapy of advanced non-small cell lung cancer: A systematic review and meta-analysis
Yu-Qiong Xu, Xiang Long, Ming Han, Ming-Qiang Huang, Jia-Fa Lu, Xue-Dong Sun, Wei Han
Yu-Qiong Xu, Ming Han, Ming-Qiang Huang, Jia-Fa Lu, Xue-Dong Sun, Wei Han, Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, Shenzhen 518000, Guangdong Province, China
Xiang Long, Department of Respiratory and Critical Care Medicine, Peking University Shenzhen Hospital, Shenzhen 518000, Guangdong Province, China
Author contributions: Han W and Xu YQ contributed to the study conception and design, the acquisition of data, and the drafting of the manuscript; Xu YQ, Long X, Han M, Huang MQ, Lu JF, and Sun XD contributed to the analysis and interpretation of the quantitative data and the drafting of the manuscript; Xu YQ, Long X, and Han M contributed to the development of critical revising of the final draft; Xu YQ and Han W contributed to the analysis and interpretation of the descriptive and revising the final draft; All authors have read and approved the manuscript.
Supported by The Sanming Project of Medicine in Shenzhen, No. SZSM201911007.
Conflict-of-interest statement: The authors have declared that no conflict-of-interest exist.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei Han, MD, Associate Chief Physician, Department of Emergency Medicine, Shenzhen University General Hospital, Shenzhen University Clinical Medical Academy, No. 1098 Xueyuan Avenue, Shenzhen 518000, Guangdong Province, China. sugh_hanwei@szu.edu.cn
Received: July 15, 2020
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
Processing time: 189 Days and 0.8 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

The motivation of this study is to investigate COX-2 for intervention of NSCLC, which is mired in controversy in the medical field.

Research objectives

This systematic review based on randomized controlled trials was conducted to appraise the benefit of chemotherapy-assisted addition of COX-2 for advanced NSCLC.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

This study can provide reference value for the application of COX-2 in the treatment of lung cancer.