First-line concomitant EGFR-TKI + chemotherapy versus EGFR-TKI alone for advanced EGFR-mutated NSCLC: a meta-analysis of randomized phase III trials.

IF 2.9 3区医学 Q2 ONCOLOGY

Expert Review of Anticancer Therapy Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI:10.1080/14737140.2024.2362889

Thierry Landre, Jean-Baptiste Assié, Kader Chouahnia, Gaetan Des Guetz, Jean-Bernard Auliac, Christos Chouaïd

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引用次数: 0

Abstract

Introduction: A tyrosine-kinase inhibitor (TKI) is indicated as a first-line treatment for patients with non-small-cell lung cancer (NSCLC) harboring an epidermal growth-factor - receptor (EGFR) mutation. Chemotherapy (ChT) given in combination with an EGFR-TKI in this setting is of interest.

Methods: We conducted a meta-analysis of phase III randomized trials comparing EGFR-TKI + ChT vs. EGFR-TKI alone as first-line therapy for advanced NSCLC harboring an activating EGFR mutation.

Results: Three studies evaluated gefitinib + ChT (NEJ009, GAP-Brain, and Noronha et al.) and another evaluated osimertinib + ChT (FLAURA-2). Those four eligible studies included 1413 patients with non-squamous NSCLCs, 826 (58%) with an exon-19 deletion (ex19del) and 541 (38%) with EGFR^L858R. The EGFR-TKI + ChT combination was significantly associated with prolonged PFS (hazard ratio [HR]: 0.52 [95% confidence interval (CI): 0.45-0.59]; p < 0.0001) and OS (HR: 0.69 [0.52-0.93]; p = 0.01). PFS was particularly improved for patients with brain metastases (HR: 0.41[0.33-0.51]; p < 0.00001).

Conclusions: For patients with untreated, advanced, EGFR-mutated NSCLCs, the EGFR-TKI + ChT combination, compared to EGFR-TKI alone, was associated with significantly prolonged PFS and OS. However, further studies are needed to identify which patients will benefit the most from the combination.

Registration: PROSPERO CRD42024508055.

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晚期表皮生长因子受体突变 NSCLC 一线联合 EGFR-TKI + 化疗与单用 EGFR-TKI：随机 III 期试验荟萃分析。

简介：酪氨酸激酶抑制剂（TKI）是携带表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者的一线治疗药物。在这种情况下，化疗（ChT）与表皮生长因子受体-TKI联用值得关注：我们对III期随机试验进行了荟萃分析，比较了EGFR-TKI + ChT与单用EGFR-TKI作为一线疗法治疗携带活化EGFR突变的晚期NSCLC的效果：三项研究评估了吉非替尼 + ChT（NEJ009、GAP-Brain 和 Noronha 等人），另一项研究评估了奥希替尼 + ChT（FLAURA-2）。这四项符合条件的研究共纳入了1413例非鳞状NSCLC患者，其中826例（58%）患者存在外显子-19缺失（ex19del），541例（38%）患者存在EGFRL858R。EGFR-TKI+ChT组合与PFS延长有显著相关性（危险比[HR]： 0.52 [95%置信区间]）：0.52[95%置信区间（CI）：0.45-0.59]；P = 0.01）。脑转移患者的生存期尤其得到改善（HR：0.41[0.33-0.51]；P 结论：脑转移患者的生存期更长（HR：0.41[0.33-0.51]）：对于未经治疗的晚期表皮生长因子受体突变 NSCLC 患者，与单用表皮生长因子受体-TKI 相比，表皮生长因子受体-TKI + ChT 联合用药可显著延长患者的 PFS 和 OS。不过，还需要进一步研究，以确定哪些患者将从联合用药中获益最多：注册号：PREMCO CRD42024508055。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Anticancer Therapy 医学-肿瘤学

CiteScore

5.10

自引率

3.00%

发文量

100

审稿时长

4-8 weeks

期刊介绍： Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.