Intercalated Combination of Chemotherapy and EGFR-TKIs versus Chemotherapy Alone in the First-line Treatment of Advanced Non-small Cell Lung Cancer：A Meta-analysis
10.3779/j.issn.1009-3419.2016.12.06
- VernacularTitle:化疗间插联合EGFR-TKIs对比单独化疗一线治疗晚期非小细胞肺癌的meta分析
- Author:
HONG CHAOYU
1
;
MEI TONGHUA
;
WANG JIN
Author Information
1. 重庆医科大学附属第一医院呼吸内科
- Keywords:
Lung neoplasms;
Chemotherapy;
Epidermal growth factor receptor-tyrosine kinase inhibitors;
Inter-calated combination;
First-line treatment;
Meta-analysis
- From:
Chinese Journal of Lung Cancer
2016;19(12):837-846
- CountryChina
- Language:Chinese
-
Abstract:
Background and objective The combination therapy of chemotherapy and epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has attracted the attention of more and more investigators. The aim of this meta-analysis is to evaluate the clinical effcacy and safety of intercalated combination of chemotherapy and EGFR- TKIs versus chemotherapy alone in the ifrst-line therapy of advanced non-small cell lung cancer (NSCLC).Methods We retrieved the Co-chrane Library, PubMed, EMBASE, CBM, CNKI and Wanfang databases for randomized controlled trials which involved the intercalated combination of chemotherapy and EGFR-TKIs, and chemotherapy alone in the first-line treatment of advanced NSCLC. hTe progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events were analyzed. hTe quality evaluation and cross-checked data were independently performed by two in-vestigators according to the Cochrane Systematic Reviews Handbook. hTe Stata 12.0 sotfware was used to conduct themeta-analysis.Results This study included 933 NSCLC patients from 6 RCTs. Themeta-analysis demonstrated that the intercalated combination of chemotherapy and EGFR-TKIs signiifcantly prolonged the PFS (HR=0.72, 95% CI: 0.53-0.98,P=0.037) of advanced NSCLC patients compared with mono-chemotherapy. However, there was no statistical difference in OS (HR=0.85, 95%CI: 0.72-1.01,P=0.060), ORR (OR=1.59, 95%CI: 0.86-2.95,P=0.142) and DCR (OR=1.09, 95% CI: 0.95-1.25,P=0.226) between the two groups. Further, the subgroup analysis showed that the intercalated combination markedly improved the PFS in female, adenocarcinoma, never smoking,EGFR mutant patients. In the aspect of safety, the main side effects of the interca-lated combination therapy were rash (OR=7.81, 95%CI: 3.74-16.34,P<0.001) and diarrhea (OR=2.73, 95% CI: 1.92-3.89, P<0.001).Conclusion hTe intercalated combination of chemotherapy and EGFR-TKIs signiifcantly prolonged the PFS in the first-line therapy of advanced NSCLC patients compared with mono-chemotherapy, and the main adverse events were toler-able rash and diarrhea. Together, the intercalated combination shows promising results, and more large-scale and high-quality RCTs are still needed.
