Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shaoyang University, Shaoyang, China.
BMJ Open. 2022 Aug 19;12(8):e062036. doi: 10.1136/bmjopen-2022-062036.
Combination treatment with erlotinib plus bevacizumab has the potential to become a standard treatment regimen for patients with epidermal growth factor receptor mutation-positive (m) advanced non-small cell lung cancer (NSCLC). This study aimed to investigate the efficacy and safety of erlotinib plus bevacizumab in patients with m advanced NSCLC.
Systematic review and meta-analysis.
The PubMed, Embase, Web of Science and Cochrane Library databases were searched, from inception to 15 January 2022.
We included randomised controlled trials (RCTs), reported in English, assessing the efficacy of erlotinib plus bevacizumab versus erlotinib monotherapy in patients with advanced NSCLC.
The main objective was to assess overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse events (AEs). Two independent reviewers extracted data and assessed the risk of bias. A random-effects model was used where there was evidence for homogeneous effects.
Four RCTs (reported across six publications) were included in the meta-analysis, with a total of 775 patients included in the pooled analyses of PFS, OS and ORR (387 in the erlotinib plus bevacizumab intervention group and 388 in the erlotinib group). Compared with the erlotinib alone group, the erlotinib plus bevacizumab group achieved a significantly prolonged PFS (HR: 0.59; 95% CI 0.49 to 0.72; p<0.00001; I=0%), but OS (HR: 0.95; 95% CI 0.78 to 1.15; p=0.59; I=0%) and ORR (OR: 1.25; 95% CI 0.89 to 1.74; p=0.19; I=0%) were not significantly prolonged. A total of 776 cases were used for a pooled analysis of AEs. Regarding AEs, combined treatment significantly increased the incidence of diarrhoea (51% vs 43%, 95% CI 1.03 to 1.38; p=0.006), haemorrhagic events (41% vs 20%, 95% CI 1.12 to 6.31; p=0.03), proteinuria (25% vs 3%, 95% CI 4.86 to 17.66; p<0.0001) and hypertension (40% vs 8%, 95% CI 3.66 to 7.88; p<0.0001).
Erlotinib plus bevacizumab for the treatment of patients with m advanced NSCLC was associated with significantly prolonged PFS compared with erlotinib alone, but the combination did not prolong OS.
厄洛替尼联合贝伐珠单抗治疗具有成为表皮生长因子受体突变阳性（m）晚期非小细胞肺癌（NSCLC）患者标准治疗方案的潜力。本研究旨在探讨厄洛替尼联合贝伐珠单抗在 m 晚期 NSCLC 患者中的疗效和安全性。
系统评价和荟萃分析。
从成立到 2022 年 1 月 15 日，检索了 PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库。
我们纳入了随机对照试验（RCT），以英语报告，评估厄洛替尼联合贝伐珠单抗与厄洛替尼单药治疗晚期 NSCLC 患者的疗效。
主要目的是评估总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）和不良事件（AE）。两名独立审查员提取数据并评估偏倚风险。如果存在同质效应的证据，则使用随机效应模型。
荟萃分析纳入了 4 项 RCT（报告了 6 篇论文），共有 775 例患者纳入 PFS、OS 和 ORR 的汇总分析（厄洛替尼联合贝伐珠单抗干预组 387 例，厄洛替尼组 388 例）。与厄洛替尼单药组相比，厄洛替尼联合贝伐珠单抗组的 PFS 显著延长（HR：0.59；95%CI 0.49 至 0.72；p<0.00001；I=0%），但 OS（HR：0.95；95%CI 0.78 至 1.15；p=0.59；I=0%）和 ORR（OR：1.25；95%CI 0.89 至 1.74；p=0.19；I=0%）无显著延长。共有 776 例用于 AE 的汇总分析。关于 AE，联合治疗显著增加了腹泻（51%比 43%，95%CI 1.03 至 1.38；p=0.006）、出血事件（41%比 20%，95%CI 1.12 至 6.31；p=0.03）、蛋白尿（25%比 3%，95%CI 4.86 至 17.66；p<0.0001）和高血压（40%比 8%，95%CI 3.66 至 7.88；p<0.0001）的发生率。
厄洛替尼联合贝伐珠单抗治疗 m 晚期 NSCLC 患者与厄洛替尼单药治疗相比，PFS 显著延长，但联合治疗并未延长 OS。
