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KMID : 1011320100030030137
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Journal of Pharmacoepidemiology and Risk Management
2010 Volume.3 No. 3 p.137 ~ p.149
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Indirect Comparison of Chemotherapeutic Strategies for Hematologic Adverse Events in Unfavorable Subset of Carcinoma of Unknown Primary: Systematic Review and Meta-analysis
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Lee Joong-yub
Han Seo-Kyung
Kim Dong-Wan
Kim Jin-Hee
Kang Se-Na
Park Nan-Hee
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Abstract
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Objective: To summarize toxicity of treatment by chemotherapeutic strategies from clinical trials on unfavorable subset of carcinoma of unknown primary (CUP).
Methods: Publications were searched from 1980 through August 2009 in MEDLINE, EMBASE and Cochrane Central Register of Controlled Trial (CENTRAL), and KoreaMed, KISS, RISS4U, KMbase. We included clinical trials on CUP chemotherapy in which abdominal CT with chest CT or chest X-ray used for diagnostic work-up. Data on prognostic factors and toxicities were extracted with a standardized form. Methodological Index for Non-Randomized Studies (MINORS) and Risk Of Bias (ROB) were used for evaluation of study quality. Outcomes were combined using inverse variance method. Meta-regression was used for adjustment of major prognostic factors. Heterogeneity was evaluated with forest plot, I-squared measure and the chi-squared test. Egger’s tests and funnel plots were used to explore publication bias.
Results: Twenty-five studies were included for analysis. Regimens with platinum or with larger number of drugs showed tendency to have more hematologic adverse events. However, taxane regimens showed tendency of less adverse events. After the adjustment of prognostic factor, these tendencies were not significant except for the increase of thrombocytopenia by regimens with larger number of drugs. Small study effect was prominent in all hematologic adverse events.
Conclusion: Larger number of drug was related to the more frequent thrombocytopenia. Small study effect and lack of standardization in adverse event reporting of clinical trial suggested potential to improve drug safety in chemotherapy of CUP.
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KEYWORD
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Carcinoma of unknown primary, Chemotherapy, Toxicity, Systematic review, Meta-analysis
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