Children, adolescents, and young adults with metastatic Ewin | Figure 1

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Children, adolescents, and young adults with metastatic Ewing sarcoma at diagnosis

High‐dose chemotherapy and haematopoietic cell transplantation for children, adolescents, and young adults with metastatic Ewing sarcoma at diagnosis

Review question

We were looking for evidence on whether high‐dose chemotherapy plus autologous haematopoietic cell transplantation (intravenous infusion of stem cells collected previously from the patient to re‐establish bone marrow) improved event‐free survival, overall survival, quality‐adjusted survival, and progression‐free survival better than conventional chemotherapy in children, adolescents, and young adults with primary metastatic Ewing sarcoma (cancer that has spread to other parts of the body at time of diagnosis). We were also looking for adverse effects that occurred because of these treatments.

Background

Ewing sarcoma is a tumour that usually occurs in the bone and soft tissue of children and young adults. People with metastatic Ewing sarcoma at diagnosis have a poor chance of survival. Less than 30% of affected people survive after five years. People with solitary lung metastases have a better chance of survival (50% survival after five years). Current treatment consists of multidrug chemotherapy combined with surgery, radiotherapy, or both. Improved therapy is essential for these people.

Study characteristics

We identified one study (267 participants, who were included over a 15‐year period, from 144 international centres) that compared high dose chemotherapy plus autologous haematopoietic cell transplantation with conventional chemotherapy and whole lung irradiation in children, adolescents, and young adults with Ewing sarcoma with pulmonary metastases at diagnosis.

Key results

In young people with pulmonary metastatic Ewing sarcoma at diagnosis, low‐certainty evidence from one study found no clear difference between treatment groups in event‐free survival. There were no data available for overall survival, quality‐adjusted survival, adverse effects, or progression‐free survival. We did not find any studies that addressed children, adolescents, and young adults with Ewing sarcoma that had metastasised to locations besides the lungs at diagnosis. We need high‐quality research before definite conclusions can be made.

Certainty of the evidence

The certainty of the evidence was low.

How current is the evidence

The evidence is current to January 2020.

Cochrane Reviews

Immunotherapy for non‐small cell lung cancer

Review question Do treatments that help the body's immune system fight cancer cells (immunotherapy) make people with non‐small cell lung cancer (NSCLC) who have had surgery or radiotherapy aimed at a cure live longer?

Background Many people with NSCLC, who have had surgery or radiotherapy to cure their cancer, eventually die because the cancer comes back, either in the chest, or somewhere else in the body. There have been a number of trials over the years that have looked at whether immunotherapy helps people live longer. Some seemed to show a benefit, others did not.

Study characteristics We searched four computerised databases and five trial registers to 19 May 2021. We looked for all trials that randomly allocated participants to one treatment or another (randomised controlled trials, RCTs), and included adults (aged 18 years or older) with early NSCLC (stages I to III), confirmed by laboratory testing of a sample of the tumour. We found 11 RCTs, which included over 5000 participants who had received surgery or curative radiotherapy and were randomly allocated to receive either immunotherapy or no further treatment.

Key results We found that giving immunotherapy, mainly vaccine‐based (aiming to activate the host immune system to induce human immune response to tumour‐specific antigens), after surgery or radiotherapy did not make people live longer. People who were given vaccine‐based immunotherapy did not seem to experience more side effects than the others. We did not find results that could tell us whether the addition of immunotherapy improved quality of life. At the moment, there is no evidence to support or refute giving immunotherapy (mainly vaccine‐based) to people with localised NSCLC (stages I to III). RCTs in progress are testing new, more promising immunotherapy drugs (e.g. checkpoint inhibitors).

Quality of the evidence The evidence we found about overall survival and progression‐free survival was of high and moderate quality, respectively. When we looked for evidence about how many participants lived to one, two, three, or five years, it was only moderate or low quality because the RCTs were not very well done and their results did not agree with each other. The evidence for both any and severe adverse events was of low quality.

Platinum‐containing chemotherapy for early triple‐negative breast cancer

Key messages Chemotherapy including the platinum‐based medicine carboplatin improves survival and reduces the chance of cancer returning for people with early triple‐negative breast cancer. However, it is also associated with increased side effects.

What is triple‐negative breast cancer? Triple‐negative breast cancer makes up 15% of breast cancer cases. It is a type of breast cancer that does not have any of the three receptors commonly found on breast cancer cells – the oestrogen, progesterone and HER2 receptors. Early breast cancer is defined as cancer limited to the breast and lymph nodes in the armpit, and it can usually be cured.

What did we find? We found 20 studies that involved 4688 people with early triple‐negative breast cancer, with average follow‐up in studies ranging from three to eight years. Platinum chemotherapy was associated with longer disease‐free survival and overall survival and reduced the chance of disease recurrence and death by about one third. These benefits were seen with chemotherapy used before surgery (neoadjuvant) or after surgery (adjuvant). When used before surgery, it also improved the likelihood of a pathological complete response. We did not find that any particular subgroup, such as people with a high‐risk gene mutation, had more benefit from platinum chemotherapy. However, people receiving platinum chemotherapy were more likely to need the dose of their chemotherapy to be reduced or to have a delay in their chemotherapy. They were also more likely to stop chemotherapy early. Platinum chemotherapy also caused more serious side effects including low blood cell counts. It was not associated with an increase in having fevers associated with low white blood cell counts (febrile neutropenia), nerve damage symptoms (neuropathy) or death caused by treatment.

What are the limitations of the evidence? The evidence was generally of high quality and included enough data to make judgements to answer our main questions. However, there were many types of chemotherapy used across studies. Although we have shown that platinum chemotherapy improves long‐term outcomes, we do not know what the best chemotherapy combination is. None of the studies reported quality of life.