Title:Efficacy and Safety of EGFR Inhibitors in the Treatment of EGFRPositive NSCLC Patients: A Meta-Analysis
Volume: 16
Issue: 2
Author(s): Amit Dang*, Sumit Dang and B.N. Vallish
Affiliation:
- MarksMan Healthcare Communications and KYT Adhere, Hyderabad, Telangana - 500032,India
Keywords:
EGFR inhibitors, non-small cell lung cancer, EGFR mutation, overall survival, progression-free survival, metaanalysis.
Abstract:
Background: We compared the response rates, survival rates, and safety profile of epidermal
growth factor receptor (EGFR) inhibitors with non-targeted chemotherapy and older EGFR
inhibitors when used to treat advanced non-small cell lung cancer (NSCLC) patients with activating
EGFR mutations.
Methods: We searched PubMed, Cochrane Central Register of Controlled Trials, and clinicaltrial.-
gov for randomized controlled trials published until 11-Feb-2020. Treatment outcomes were compared
between EGFR inhibitor and pooled comparator; a subgroup analysis compared outcomes between
EGFR inhibitor and non-targeted chemotherapy, and between newer and older EGFR inhibitors.
Results: Twenty-one studies with 4,250 unique patients were included. Significantly higher objective
response rate (ORR) (odds ratio (OR) 2.28; 95% CI 2.00-2.61), higher disease control rate (DCR)
(OR 2.3; 95% CI 1.88-3.06), and longer progression-free survival (PFS) (Hazard ratio (HR)
0.56; 95% CI 0.52-0.60) were observed in the EGFR inhibitor group compared to the pooled comparator
group. Subgroup analysis revealed that the ORR, DCR, and PFS were significantly higher
with EGFR inhibitors than non-targeted chemotherapy, and only PFS (and not ORR and DCR) was
significantly longer with newer EGFR inhibitors than the older EGFR inhibitors. Overall survival
(OS) was not significantly different between EGFR inhibitors and pooled comparator (HR 0.91;
95% CI 0.83-1.00) as well as in either of the subgroup analyses. Adverse events ≥ grade 3 and treatment
discontinuation were significantly higher with non-targeted chemotherapy compared to the
EGFR inhibitors.
Conclusion: The benefits of prolongation of ORR, DCR, and PFS might not imply significantly improved
OS after therapy with EGFR inhibitors when compared with non-targeted chemotherapy or
older EGFR inhibitors.
