The review included 8 RCTs with 2,374 participants.
Based on intention-to-treat data from 8 RCTs, platinum-based doublet therapy was associated with a higher objective response than single agent therapy (OR 2.32, 95% confidence interval, CI: 1.68, 3.20). There was statistically significant heterogeneity (p=0.017), with people with stage IV disease being more likely to have a reduced response (p=0.01).
Based on intention-to-treat data from 5 RCTs and selected patients in 3 other trials, platinum-based doublet therapy was associated with a 13% improvement in overall survival (HR 0.87, 95% CI: 0.80, 0.94, p<0.001).
Platinum-based doublet therapy was associated with a statistically significant increase in the incidence of neutropenia (5 trials; OR 3.12, 95% CI: 1.98, 4.91), thrombocytopenia (6 trials; OR 14.4, 95% CI 6.75, 30.5), nephrotoxicity (7 trials; OR 6.44, 95% CI: 2.95, 14.0) and nausea or vomiting (6 trials; OR 4.01, 95% CI: 1.94, 8.30). However, there was no statistically significant difference in treatment-related mortality (OR 0.97, 95% CI: 0.41, 2.26, p=0.94).
Funnel plots and rank correlation tests found no evidence of publication bias for response, survival, or toxicity.