title: Chemotherapy with or without gefitinib in patients with advanced non-small-cell lung cancer: a meta-analysis of 6,844 patients.
abstract: BACKGROUND
  Gefitinib is widely used in patients with advanced non-small-cell lung cancer (NSCLC), in whom chemotherapy had failed. Previous trials reported inconsistent findings regarding the efficacy of gefitinib on overall survival (OS) and progression free survival (PFS). This study was to evaluate the effects of chemotherapy plus gefitinib versus chemotherapy alone on survival of patients with NSCLC.
  
  
  METHODS
  We systematically searched Medline, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings for relevant literature. Randomized controlled trials (RCTs) comparing chemotherapy with and without gefitinib in the treatment of patients with advanced NSCLC were included in our analysis. The primary endpoints were OS and PFS.
  
  
  RESULTS
  Of 182 relevant studies, 12 were included in the final analysis, which consisted of 6844 patients with NSCLC. Overall, we noted that gefitinib therapy had an 8% improvement in the OS as compared to the gefitinib-free therapy, but this difference was not statistically significant (HR, 0.92; 95% CI: 0.85-1.00; P=0.051). Furthermore, gefitinib therapy had significantly longer PFS compared to gefitinib-free therapy (HR, 0.72; 95% CI 0.60-0.87, P=0.001). Patients receiving gefitinib therapy also had a more frequent objective response rate (ORR) than the control arm (OR, 2.51; 95% CI, 1.67-3.78, P < 0.001). Rashes, diarrhea, dry skin, pruritus, paronychia, and abnormal hepatic function were more frequent in the gefitinib therapy group.
  
  
  CONCLUSIONS
  Treatment with gefitinib had a clear effect on PFS and ORR, and it might contribute considerably to the OS. Furthermore, there was some evidence of benefit for gefitinib therapy among patients with adenocarcinoma.
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.forename: Chao
authors.initials: C
authors.lastname: Zeng
authors.forename: Li-Yang
authors.initials: LY
authors.lastname: Wang
authors.forename: Hua
authors.initials: H
authors.lastname: Xie
authors.forename: Jin
authors.initials: J
authors.lastname: Zhou
authors.forename: Peng
authors.initials: P
authors.lastname: Diao
authors.forename: Wen-Xiu
authors.initials: WX
authors.lastname: Yao
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Yang
authors.initials: Y
authors.lastname: Wei
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D011799:Quinazolines / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib