Qiao Lifen, Wang Jin, Long Guoxian, Jiang Yueqiang
Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.
Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Emergency.
Onco Targets Ther. 2017 Feb 28;10:1279-1284. doi: 10.2147/OTT.S128187. eCollection 2017.
There is debate surrounding which treatment is superior in overall survival (OS) rates in patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC); first-line tyrosine kinase inhibitor (TKI) followed by second-line platinum-based doublet chemotherapy (PCT), or the reverse sequence. Cross treatment of first- and second-line TKI and PCT makes it difficult to deduce which sequence (TKI-PCT or PCT-TKI) is better for OS. Using the keywords "lung cancer" and "EGFR" we identified clinical trials within the PubMed database which were published between January 2006 and November 2016. Basic characteristics and OS with hazard ratio and 95% confidence intervals were searched and analyzed. In total, 457 articles were reviewed and nine clinical trials with 1,876 patients were of sufficient quality for further analysis. Fixed effects models were performed to pool the data in this meta-analysis. All nine studies were open-labeled, multicenter, Phase III randomized controlled clinical trials. The pooled hazard ratio was 0.96 (95% confidence interval: 0.84-1.10) for OS between first-line TKI followed by second-line PCT compared to the reverse sequence. No statistically significant heterogeneity (=0, =0.553) nor publication bias (Egger's =0.991) was observed among these studies. In conclusion, there was no OS benefit between first-line TKI followed by second-line PCT compared to the reverse sequence in EGFR mutant NSCLC patients. Chemotherapy was still useful and irreplaceable for the treatment of NSCLC, especially for those patients with EGFR unavailable for testing.
对于表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者，哪种治疗方案的总生存期（OS）率更优存在争议：是一线酪氨酸激酶抑制剂（TKI）序贯二线铂类双联化疗（PCT），还是相反的顺序。一线和二线TKI与PCT的交叉治疗使得难以推断哪种顺序（TKI-PCT或PCT-TKI）对OS更有利。使用关键词“肺癌”和“EGFR”，我们在PubMed数据库中识别了2006年1月至2016年11月期间发表的临床试验。检索并分析了基本特征以及带有风险比和95%置信区间的OS。总共审查了457篇文章，9项涉及1876例患者的临床试验质量足以进行进一步分析。在这项荟萃分析中采用固定效应模型来汇总数据。所有9项研究均为开放标签、多中心、III期随机对照临床试验。与相反顺序相比，一线TKI序贯二线PCT的OS合并风险比为0.96（95%置信区间：0.84-1.10）。在这些研究中未观察到统计学上显著的异质性（I²=0，P=0.553）和发表偏倚（Egger检验P=0.991）。总之，在EGFR突变的NSCLC患者中，一线TKI序贯二线PCT与相反顺序相比，OS并无获益。化疗对于NSCLC的治疗仍然有用且不可替代，尤其是对于那些无法进行EGFR检测的患者。
