Efficacy of adjuvant EGFR inhibitors and impact of clinical factors in resected EGFR-mutated non-small-cell lung cancer: a meta-analysis

Background: The role of adjuvant EGFR tyrosine kinase inhibitors (TKIs) in resected EGFR-mutated non-small-cell lung cancer (NSCLC) remains unclear. Materials & methods: We evaluated pooled hazard ratio and 95% CI for disease-free survival, overall survival and prespecified subgroups. Results: Seven prospective studies with 1288 patients were included in the meta-analysis. Adjuvant EGFR TKIs significantly improved disease-free survival in EGFR-mutated resected NSCLC (HR: 0.41; 95% CI: 0.24-0.70) and in all subgroups. However, the overall survival benefit was not significant (HR: 0.65; 95% CI: 0.36-1.17). The benefit of adjuvant TKIs may be associated with TKI regimens, treatment duration, pathological stage and EGFR mutation type. Conclusion: Adjuvant EGFR TKIs significantly improved disease-free survival and nonsignificantly improved overall survival in resected EGFR-mutated NSCLC. Plain language summary For lung cancer patients who undergo radical surgery and whose tumors have EGFR mutation (a specific gene alteration in the tumor tissue), the optimal treatment following surgery is unclear. We summarized the available studies to compare the efficacy of anti-EGFR targeted therapies (EGFR inhibitors) with chemotherapy in patients after surgery. We found patients who received EGFR inhibitors after surgery had longer survival without disease recurrence, and a tendency toward longer overall survival than patients who received chemotherapy or no further therapy. The different treatment regimes, treatment duration, tumor stage and EGFR mutation type may impact the efficacy of EGFR inhibitors in these patients after undergoing surgery.

Automated summary

Adjuvant EGFR tyrosine kinase inhibitors significantly improved disease-free survival and nonsignificantly improved overall survival in resected EGFR-mutated NSCLC. Different treatment regimes, treatment duration, tumor stage, and EGFR mutation type may impact the efficacy of EGFR inhibitors in these post-surgery patients.