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from Perrine Créquit,Ludovic Trinquart,Amélie Yavchitz, and Philippe Ravaud


For many conditions, multiple competing treatments are available, many of which have been assessed in randomized trials [1]. Clinicians and patients who are making medical decisions need to know which treatment works best among all treatments for the condition of interest. They increasingly turn to systematic reviews and meta-analyses for current evidence-based assessments of the relative benefits and harms of treatments.

To decide the best treatment for a patient, clinicians and patients need a comprehensive, up-to-date synthesis of evidence for all treatments available for a given condition [2–4]. This synthesis could be provided by considering the whole set of conventional meta-analyses on all treatment comparisons or a network meta-analysis [5].

However, systematic reviews as currently performed may fail to meet clinicians’ and patients’ needs [6]. Systematic reviews and meta-analyses are insufficiently informative if they do not cover all alternative treatments or do not include all available current evidence. In fact, most meta-analyses have a narrow scope and focus on specific treatments [7]. Moreover, many meta-analyses become quickly out-of-date because clinically important evidence can accumulate rapidly, but updating a systematic review can be as costly and time-consuming as the original review [8, 9]. This failure to rigorously synthesize the totality of relevant evidence may have a detrimental effect on treatment decisions and future research planning.

The exponential growth in publications of randomized trials, especially in oncology, increases clinicians’ and patients’ need for broad meta-analyses encompassing all the evidence for all competing treatments [10]. Lung cancer, in particular, remains the fifth leading cause of disability-adjusted life years in developed countries and represents a key area of current therapeutic innovation [11]. With recent progresses in therapeutics, the number of patients with advanced non-small cell lung cancer (NSCLC) who receive second-line treatments is increasing, but which second-line treatment to recommend is unclear.

We used the example of NSCLC to quantify the waste of research related to systematic reviews failing to provide a complete and up-to-date synthesis of evidence over time.

read also why lung cancer in asia to difficult here

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