{"entity":{"id":"paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995","kind":"paper","name":"Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials","aka":[],"tldr":"Before 1995 many doctors thought chemotherapy did nothing for lung cancer. Pooling 9,387 patients from 52 trials showed it did something: a 27 percent reduction in the risk of death when added to supportive care, worth about 10 percent more people alive at one year.","summary":"The Non-small Cell Lung Cancer Collaborative Group's individual-patient-data meta-analysis of all available randomised trials, published and unpublished: 9,387 patients and 7,151 deaths from 52 trials.\n\nIts importance is as much methodological as clinical. It is an early demonstration that individual patient data, collected from investigators rather than read off published tables, can settle a question that a decade of separate underpowered trials had left open, and it is the paper that made cisplatin-based chemotherapy a standard rather than an option in non-small-cell lung cancer.","asOf":"2026-09-25","links":[{"label":"BMJ 1995","url":"https://europepmc.org/article/MED/7580546"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/7580546/"}],"tags":["lung-evidence"],"related":["chemotherapy-roadmap","paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002"],"cancers":["lung-cancer","nsclc"],"sections":["drug-discovery"],"technologies":["radiotherapy"],"targets":[],"drugs":["cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":["neoadjuvant-adjuvant"],"trials":[],"people":[],"bottlenecks":["b-trial-design","b-negative-results","b-real-world-evidence"],"keyPapers":[],"journals":["bmj"],"dependsOn":[],"notes":[],"journal":"BMJ","year":1995,"pmid":"7580546","authors":"Non-small Cell Lung Cancer Collaborative Group.","paperType":"meta-analysis","findings":["Surgery plus chemotherapy against surgery alone: hazard ratio 0.87, a 13 percent reduction in the risk of death, an absolute benefit of 5 percent at five years.","Radical radiotherapy plus chemotherapy against radiotherapy alone: hazard ratio 0.87, an absolute benefit of 4 percent at two years.","Supportive care plus chemotherapy against supportive care alone: hazard ratio 0.73, a 27 percent reduction in the risk of death and a 10 percent improvement in survival at one year.","The essential drugs needed to achieve these effects were not identified.","No difference in the size of effect was seen in any subgroup of patients.","Older trials using long-term alkylating agents tended to show a detrimental effect, reaching conventional significance in the adjuvant surgical comparison."],"whatItMeans":"The paper that ended therapeutic nihilism in lung cancer. The effect was small, and saying so honestly is what made it credible; every later trial in advanced disease is measured against the platinum doublet this analysis justified.","caveats":["Trials from the 1960s to the early 1990s, with staging, supportive care and radiotherapy of that era.","It could not identify which drugs produced the benefit, and the regimens tested are not the ones used now.","An absolute five-year benefit of about 5 percent after surgery is real but modest, and comes with the toxicity of cisplatin."],"changedPractice":true,"participants":9387},"route":"/key-papers/paper-nsclc-collaborative-group-chemotherapy-meta-analysis-bmj-1995/","neighbours":{"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"paper":[{"id":"paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002","kind":"paper","name":"Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer","route":"/key-papers/paper-schiller-ecog-1594-four-chemotherapy-regimens-nejm-2002/"},{"id":"paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008","kind":"paper","name":"Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group","route":"/key-papers/paper-lace-adjuvant-cisplatin-pooled-analysis-jco-2008/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"drug-discovery","kind":"section","name":"Drug Discovery Platforms","route":"/fronts/drug-discovery/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"},{"id":"radiotherapy","kind":"term","name":"Radiotherapy","route":"/terms/radiotherapy/"}],"drug":[{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"}],"bottleneck":[{"id":"b-negative-results","kind":"bottleneck","name":"Failures are hidden","route":"/bottlenecks/b-negative-results/"},{"id":"b-trial-design","kind":"bottleneck","name":"Trial design, endpoints and cost","route":"/bottlenecks/b-trial-design/"},{"id":"b-real-world-evidence","kind":"bottleneck","name":"Weak real-world evidence and registries","route":"/bottlenecks/b-real-world-evidence/"}],"journal":[{"id":"bmj","kind":"journal","name":"BMJ","route":"/journals/bmj/"}]}}