Efficacy and safety of EGFR-TKIs monotherapy versus combination therapy as first-line treatment for advanced non-small cell lung cancer: a network meta-analysis
10.12206/j.issn.2097-2024.202504044
- VernacularTitle:EGFR-TKIs单药及联合方案一线治疗晚期非小细胞肺癌的疗效与安全性：一项网状meta分析
- Author:
Guanxu CHEN
1
;
Yutong SONG
2
;
Xiuqiang GUO
3
;
Mi ZHANG
3
;
Zhihong LIU
3
;
Hongtao SONG
3
Author Information
1. Department of Pharmacy, West China Xiamen Hospital of Sichuan University, Xiamen 361000, China;Department of Pharmacy, No. 900 Hospital of Joint Logistics Support Force of PLA, Fuzhou 350025, China.
2. The First School of Clinical Medicine, Nanjing Medical University, Nanjing 211166, China.
3. Department of Pharmacy, No. 900 Hospital of Joint Logistics Support Force of PLA, Fuzhou 350025, China.
- Publication Type:Medicine&Clinical
- Keywords:
EGFR-TKIs;
non-small cell lung cancer;
EGFR mutation;
network meta-analysis;
first-line treatment
- From:
Journal of Pharmaceutical Practice and Service
2026;44(10):515-524
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy and safety of EGFR-TKIs monotherapy and its combination therapy in the first-line treatment of advanced non-small cell lung cancer （NSCLC） patients with EGFR mutations. Methods Databases such as PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were systematically searched to collect eligible phase Ⅱ/Ⅲ randomized controlled trials （RCTs）, with the time range from the establishment of the databases to June 2023. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in the studies. Outcome data, including overall survival （OS）, progression-free survival （PFS）, objective response rate （ORR）, grade 3 or higher adverse events （≥3 AEs）, and serious adverse events （SAEs）, were collected. A network meta-analysis was performed using R software （version 4.2.1） under the Bayesian theoretical framework. Subgroup analyses of survival outcomes （OS, PFS） were conducted based on different clinical and pathophysiological characteristics of the patients. Results A total of twenty-eight phase Ⅱ/Ⅲ RCTs were included in the study, involving a total of 7 460 patients and 18 first-line treatment regimens. The results showed that in terms of efficacy, gefitinib + pemetrexed-containing chemotherapy performed best in OS and ORR, while osimertinib + bevacizumab performed best in PFS. In terms of safety, furmonertinib had the lowest incidence of ≥3 grade AEs, and osimertinib had the lowest incidence of SAEs. Subgroup analysis results indicated that the efficacy and safety of various treatment regimens differed among patients with different clinical and pathological characteristics. Conclusion Monotherapy with third-generation EGFR-TKIs, represented by osimertinib, serves as the preferred therapeutic option considering both efficacy and safety profiles. While some combination therapies could enhance survival benefits, need to be vigilant about increased toxicity. Clinical decision-making should be tailored based on patients’ mutation subtypes, comorbidities, and tolerance.
