期刊
LUNG CANCER
卷 85, 期 1, 页码 66-73出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.lungcan.2014.03.026
关键词
EGFR wild-type; EGFR-TKI; Non-small cell lung cancer; Erlotinib; Gefitinib; Chemotherapy; Meta-analysis
资金
- Key Technologies R&D Program of Guangzhou [2011Y2-00014]
- Key Laboratory Program of Guangdong [2012A061400006]
Background: EGFR mutation status is closely related to the efficacy of EGFR-TKIs in advanced non-small cell lung cancer (NSCLC). EGFR-TKIs have become the standard first-line treatment for advanced EGFR-mutation NSCLC, while for EGFR wild-type tumors, the preferred first-line treatment is chemotherapy. However, the efficacy of EGFR-TKIs as second-line treatment in EGFR wild-type NSCLC remains controversial. We sought to evaluate the effectiveness of EGFR-TKI as second-line treatment in EGFR wild-type NSCLC. Methods: Randomized controlled trials that compared EGFR-TKIs with chemotherapy in previously treated advanced NSCLC with wild-type EGFR were included. We performed a meta-analysis to evaluate the effectiveness of EGFR-TKIs compared with standard chemotherapy. The endpoints were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Results: Six randomized controlled trials with a total of 990 patients with wild-type EGFR were included: 499 in the EGFR-TKIs group and 491 in the chemotherapy group. The results indicated that in the second-line treatment of EGFR wild-type advanced NSCLC, PFS was significantly inferior in the EGFR-TKIs group versus the chemotherapy group (HR = 1.37, 95% CI = 1.20-1.56, P<0.00001). However, this significant difference did not translate into OS (HR = 1.02, 95% CI = 0.87-1.20, P = 0.81). ORR tended to favor chemotherapy but there was no significant difference compared with EGFR-TKI (RR = 1.77, 95% CI = 0.90-3.50, P = 0.10). Conclusions: Chemotherapy improves PFS significantly but not OS, compared with EGFR-TKIs as a second-line treatment in advanced NSCLC with wild-type EGFR. Whether EGFR-TKIs should be used in EGFR wild-type patients should be considered carefully. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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