Literature Search Strategy
MEDLINE (1985 through October 2005), CANCERLIT (1985 through March 2002), and the Cochrane Library (2005, Issue 4) databases were searched. Studies published prior to 1985 were excluded. Because the standard first-line treatment, since the mid-1980s, has been a platinum analogue and etoposide rather than the older regimen of cyclophosphamide, doxorubicin and vincristine (CAV), these trials would not represent the patient population receiving second-line therapy today.
"Carcinoma, small cell" (Medical subject heading [MeSH]) was combined with the MeSH terms "lung neoplasms," "neoplasm recurrence, local," "recurrence," "antineoplastic agents," "drug therapy," and "salvage therapy," and the following phrases used as text words: "small cell lung," "relapse," "recur," "refractory," "second-line," "salvage," "rechallenge," "retreat," and "reinduct." These terms were then combined with the search terms for the following publication types: practice guidelines, systematic reviews, meta-analyses, randomized controlled trials, controlled clinical trials, multicentre studies, and comparative studies.
In addition, the conference proceedings of the American Society of Clinical Oncology (ASCO, 1997-2005) and the International Association for the Study of Lung Cancer (IALSC, 2005) were searched. The Canadian Medical Association Infobase (http://mdm.ca/cpgsnew/cpgs/index.asp) and the National Guideline Clearinghouse (http://www.guideline.gov/) were also searched for existing evidence-based practice guidelines. Relevant articles and abstracts were selected and reviewed, and the reference lists from those sources were searched for additional trials, as were the reference lists from relevant review articles.
Study Selection Criteria
Articles published as full reports or as abstracts were selected for inclusion in this systematic review of the evidence if they were the following:
- Randomized trials (phase II and phase III) comparing chemotherapy versus no chemotherapy or comparing different chemotherapy regimens as second-line treatment for small cell lung cancer (SCLC), and reporting data on survival or response rate
- Evidence-based practice guidelines, systematic reviews, or meta-analyses of randomized trials on chemotherapy for patients with relapsed small cell lung cancer
The following were excluded from the systematic review of the evidence:
- Articles published in a language other than English
- Trials with a primary focus on first-line treatment or that included a mix of untreated and previously treated patients