title: Cumulative meta-analysis of epidermal growth factor receptor-tyrosine kinase inhibitors as first-line therapy in metastatic non-small-cell lung cancer.
abstract: We carried out a meta-analysis to evaluate the benefit of epidermal growth factor-tyrosine kinase inhibitors (EGFR-TKI) over the standard first-line platinum-based chemotherapy for metastatic non-small-cell lung cancer (NSCLC). Studies that were considered eligible included controlled prospective randomized phase III studies in patients with NSCLC stages IIIB or IV. These patients received standard first-line platinum-based chemotherapy or EGFR-TKI; overall survival and progression-free survival (PFS) with adequate data were available to calculate and estimate the hazard ratio (HR) with a confidence interval (CI) of 95%. Eight studies were identified that compared EGFR-TKI versus standard first-line platinum-based chemotherapy to treat NSCLC in 2962 patients. Patients receiving EGFR-TKI showed significantly longer PFS [HR=0.266 (95% CI=0.20-0.35), P<0.0001]. No significant difference in overall survival [HR=0.946 (95% CI=0.35-2.53), P=0.912] was observed between the groups. The cumulative meta-analysis of the studies showed that, since 2011 (OPTIMAL study), the PFS benefit in the EGFR-TKI arm was statistically significantly longer. Toxicity values greater than or equal to 3 in the most prevalent EGFR-TKI group included skin rash, diarrhea, and increased aminotransferase. EGFR-TKI treatment significantly extends PFS, with acceptable toxicities than platinum-based chemotherapy. Thus, they should be considered as the first choice in the first-line treatment for patients with NSCLC and with the EGFR mutation.
authors.affiliation: Discipline of Oncology and Hematology, Faculty of Medicine of ABC (FMABC), Santo André, São Paulo, Brazil.
authors.forename: Sávia R C
authors.initials: SR
authors.lastname: Normando
authors.forename: Felipe M
authors.initials: FM
authors.lastname: Cruz
authors.forename: Auro
authors.initials: A
authors.lastname: Del Giglio
mesh_terms: D000077716:Afatinib; D000970:Antineoplastic Agents / Q000627:therapeutic use* / Q000633:toxicity; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000556:secondary; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011788:Quality of Life; D011799:Quinazolines / Q000627:therapeutic use / Q000633:toxicity
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077716:Afatinib; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib