Date of Award

2020

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this EBM review is to determine whether or not crizotinib works better in reducing the chest pain of ALK-positive non-small cell lung cancer (NSCLC) patients compared with chemotherapy.

Study Design: This paper evaluates three randomized controlled trials (RCTs), which were all published in peer-reviewed journals in English after 2013.

Data Sources: Three RCTs comparing the efficacy of crizotinib in reducing the chest pain in ALKpositive non-small cell lung cancer patients with chemotherapy including pemetrexed and docetaxel. Articles were selected via PubMed based on the outcomes of the studies mattered to patients (POEM).

Outcomes Measured: The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 13-item lung cancer module (EORTC QLQ-LC13) was completed by patients, the scores were used to measure lung cancer specific symptoms including chest pain.

Results: All the three RCTs articles (Shaw 2013, Solomon, 2014, Blackhall 2014) showed that crizotinib is more effective in decreasing the chest pain in ALK-positive NSCLC patients than chemotherapy (P<0.001 [pemetrexed or docetaxel], P<0.001 [pemetrexed], P<0.05 [pemetrexed] and P<0.001 [docetaxel]). All these studies suggest that crizotinib is superior to chemotherapy (pemetrexed or docetaxel) in reducing chest pain for ALK-positive NSCLC patients.

Conclusions: The data analysis of these studies indicates crizotinib works better in reducing the chest pain in ALK-positive NSCLC patients compared with chemotherapy including pemetrexed and docetaxel. The studies are limited to ALK-positive NSCLC patients. The treatments in the studies are not double-blinded, chest pain could be caused by other factors such as anxiety, which were not evaluated in this study.

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