Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
BMC Cancer. 2022 May 7;22(1):514. doi: 10.1186/s12885-022-09592-3.
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) are the current standard of care for advanced or metastatic non-small cell lung cancer (NSCLC) patients harboring EGFR activating mutations. However, the optimal strategy for elderly NSCLC patients is still under debate. This study was designed to explore the optimal first-line regimens by comparing diverse strategies for elderly and non-elderly EGFR-mutated NSCLC patients.
A systematic review was conducted to summarize all available randomized controlled trials (RCTs) from PubMed, EMBASE, Cochrane Central Register of Controlled Trials databases, and international conferences before September 30, 2020. The primary outcome was progression free survival (PFS), and the secondary outcome was overall survival (OS). A network meta-analysis (NMA) was constructed using the Bayesian statistical model to synthesize the survival outcomes of all the treatments.
In total, 12 RCTs were deemed eligible for inclusion with 3779 patients who have received 10 diverse treatments including EGFR-TKIs. Results from the Bayesian ranking suggested that osimertinib was most likely to rank the first in overall population and in elderly patients in PFS, with the cumulative probabilities of 42.20% and 31.46%, respectively. In non-elderly group (younger than 65 years old), standard of care (SoC, representing first-generation EGFR-TKIs in this NMA) + chemotherapy ranked the first (31.66%). As for OS, SoC + chemotherapy ranked first in all patients (64.33%), patients younger than 65 years old (61.98%), or older than 65 years old (34.45%).
The regimen of osimertinib is associated with the most favorable PFS in elderly advanced EGFR-mutated NSCLC patients, while SoC + chemotherapy is the optimal strategy in PFS for non-elderly NSCLC patients harboring EGFR activating mutations, and in OS for both elderly and non-elderly EGFR-mutated advanced NSCLC patients.
INPLASY protocol 2020100061 https://doi.org/10.37766/inplasy2020.20.0061 .
表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）是目前治疗携带 EGFR 激活突变的晚期或转移性非小细胞肺癌（NSCLC）患者的标准治疗方法。然而，老年 NSCLC 患者的最佳治疗策略仍存在争议。本研究旨在通过比较老年和非老年 EGFR 突变型 NSCLC 患者的不同治疗策略，探讨最佳的一线治疗方案。
系统检索 PubMed、EMBASE、Cochrane 中心对照试验注册数据库和 2020 年 9 月 30 日前国际会议的所有可用随机对照试验（RCT），总结所有可用数据。主要结局为无进展生存期（PFS），次要结局为总生存期（OS）。采用贝叶斯统计模型构建网络荟萃分析（NMA），综合所有治疗的生存结局。
共纳入 12 项 RCT，纳入 3779 例接受 10 种不同治疗的患者，包括 EGFR-TKIs。贝叶斯排序结果显示，奥希替尼在总体人群和老年患者的 PFS 中最有可能排名第一，累积概率分别为 42.20%和 31.46%。在非老年组（<65 岁），标准治疗（SoC，代表本 NMA 中的第一代 EGFR-TKI）+化疗排名第一（31.66%）。对于 OS，SoC+化疗在所有患者（64.33%）、<65 岁患者（61.98%）或>65 岁患者（34.45%）中排名第一。
奥希替尼治疗方案与老年晚期 EGFR 突变型 NSCLC 患者的最佳 PFS 相关，而 SoC+化疗是携带 EGFR 激活突变的非老年 NSCLC 患者的最佳 PFS 策略，也是老年和非老年晚期 EGFR 突变型 NSCLC 患者的最佳 OS 策略。
INPLASY 方案 2020100061 https://doi.org/10.37766/inplasy2020.20.0061。
