Objective: Several clinical trials have shown that advanced nonsmall cell lung cancer (NSCLC) patients can benefit from treatment with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy than receiving platinum-based doublets chemotherapy in the first-line treatment of advanced NSCLC; the objective of this study was to evaluate whether patients could be treated with EGFR-TKI for advanced NSCLC in the first-line setting.
Patients and methods: A literature search was conducted on the Cochrane Controlled Trials Register Databases, MEDLINE, EMBASE, Web of Science databases, and Chinese Biomedical Literature Database without exclusion of material published in any language. We performed a meta-analysis of five randomized studies that compared EGFR-TKI with platinum-based doublets chemotherapy for the patients of advanced NSCLC in the first-line setting. The primary end-point was the progression-free survival (PFS) of each treatment arm. The secondary end-points were overall survival (OS), objective response rate (ORR), adverse effects, and quality of life (qol).
Results: Five randomized controlled trials totaling 2080 patients were included in the review. Meta-analysis results are as follows: There were statistically significant differences in overall PFS (hazard ratio [HR] =0.47; 95% confidence interval [CI]: [0.27, 0.83], P = 0.009) and the PFS of the EGFR-M + subgroup (HR = 0.29; 95% CI: [0.17-0.51], P < 0.0001). Compared with patients receiving the platinum-based doublets chemotherapy group, there were no statistically significant differences between the two groups with regard to overall OS (HR = 0.92; 95% CI: [0.80-1.06], P = 0.25).
Conclusion: Compared with the platinum-based doublets chemotherapy, EGFR-TKI significantly prolonged PFS, increased ORR, improved qol, not significantly increased the nonhematologic toxicity and at the same time decreased the nonhematologic toxicity but not significantly increased the transaminase toxicity for advanced NSCLC patients in East Asia. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample trials.