In patients achieving a complete response following treatment for small-cell lung cancer (SCLC), several therapeutic approaches have been tested to improve outcome, with contrasting results. This meta-analysis was conducted to assess the role of maintenance or consolidation therapy in the treatment of SCLC and to indirectly compare the effect of chemotherapy, interferons, and other biological agents.

The literature was searched for RCTs comparing maintenance or consolidation therapy versus placebo or follow-up alone until December 2008 and 21 RCTs involving 3688 patients were identified, comprising. Eleven of the RCTs employed chemotherapy, 6 interferons (4 alpha and 2 gamma), and 4, other biological agents.

The following findings were reported (p < 0.05 was chosen as significant level for statistical tests):

• No statistical advantage in overall survival (OS) [hazard ratio, 0.93, 95% CI, 0.87 to 1.00; p = 0.05] or in progression free survival (PFS) [0.98; 0.91 to 1.06; p = 0.63] was reported for maintenance or consolidation therapy.

• Statistical evidence of different effects among the four types of therapy was detected for OS (p = 0.04), but not for PFS.

• A statistically significant reduction of mortality was detected in those studies assessing the efficacy of chemotherapy (0.89; 0.81 to 0.98; p = 0.02) and of interferon-alpha (0.78; 0.64 to 0.96; p = 0.02).

The researchers concluded that “the maintenance or the consolidation approach failed to improve the outcomes of SCLC. A survival advantage is suggested for maintenance chemotherapy and interferon-alpha, but its clinical impact needs to be confirmed by further studies.”