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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.
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Cancer Collaborative Group's individual-patient-data meta-analysis of all available randomised trials, published and unpublished: 9,387 patients and 7,151 deaths from 52 trials.
Its 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.
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.
The rule that a patient with a resected stage II or III lung cancer is offered chemotherapy and a patient with a small stage I tumour is not. Everything added to adjuvant treatment since has had to beat, or be added to, this 5 percent.
The ceiling of undirected cytotoxic chemotherapy, measured precisely. Everything that came afterwards, from histology-directed pemetrexed to EGFR inhibitors to checkpoint blockade, is an attempt to break a plateau this trial demonstrated could not be broken by changing the drugs.
Shares Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer, Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs, Cisplatin, Lung cancer (all types) and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, 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, Neoadjuvant / adjuvant / perioperative, Cisplatin and the tag lung-evidence.
Shares Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group, 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, Neoadjuvant / adjuvant / perioperative, Cisplatin and the tag lung-evidence.
Shares 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, Neoadjuvant / adjuvant / perioperative, Trial design, endpoints and cost, Cisplatin and the tag lung-evidence.
Shares BMJ, 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, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares 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, Neoadjuvant / adjuvant / perioperative, Trial design, endpoints and cost, Cisplatin and the tag lung-evidence.
Shares Radiotherapy, 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, Cisplatin, Lung cancer (all types) and the tag lung-evidence.
Shares 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, Failures are hidden, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.