Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, Shaanxi 710061, China.
Dis Markers. 2023 Apr 10;2023:5272125. doi: 10.1155/2023/5272125. eCollection 2023.
To assess the use of cytotoxic drugs as first-line chemotherapy for nonsquamous non-small-cell lung cancer (NSCLC) with EGFR mutation.
This study uses the network meta-analysis (NMA) method, with the inclusion of prospective randomized control studies related to the treatment of EGFR-positive nonsquamous NSCLC, to compare the efficacy of various EGFR-TKIs. As of September 4, 2022, 16 studies on a total of 4180 patients were included. The retrieved literature was comprehensively evaluated as per the established inclusion and exclusion criteria, and valid data were extracted and included for analysis.
The 6 treatment regimens included cetuximab, CTX (cyclophosphamide), icotinib, gefitinib, afatinib, and erlotinib. All of the 16 studies reported their findings about overall survival (OS), and 15 of them also reported findings about progression-free survival (PFS). The NMA results showed that there was no significant difference in OS among the 6 treatment regimens. It was observed that erlotinib had the highest likelihood of obtaining the best OS, followed by afatinib, gefitinib, icotinib, CTX, and cetuximab, in descending order. This indicates that the highest possibility of achieving the best OS was with erlotinib, while the lowest was with cetuximab. The NMA results also showed that the PFS achieved with treatment using afatinib, erlotinib, and gefitinib were all higher than that with treatment using CTX, with statistically significant differences. The results showed that there was no significant difference in PFS among erlotinib, gefitinib, afatinib, cetuximab, and icotinib. CTX, cetuximab, icotinib, gefitinib, afatinib, and erlotinib were ranked in descending order based on the PFS indicator SUCRA values, which implied that erlotinib had the highest possibility in achieving the best PFS, while CTX had the lowest. . EGFR-TKIs must be carefully selected for the treatment of different histologic subtypes of NSCLC. For EGFR mutation (+) nonsquamous NSCLC, erlotinib is most likely to achieve the best OS and PFS, which makes it the first choice in the formulation of a treatment plan.
评估 EGFR 突变的非鳞状非小细胞肺癌（NSCLC）一线使用细胞毒药物化疗的情况。
本研究采用网状 Meta 分析（NMA）方法，纳入与 EGFR 阳性非鳞状 NSCLC 治疗相关的前瞻性随机对照研究，比较各种 EGFR-TKI 的疗效。截至 2022 年 9 月 4 日，共纳入 16 项涉及 4180 例患者的研究。根据既定的纳入和排除标准，对检索到的文献进行全面评估，并提取和纳入有效数据进行分析。
6 种治疗方案包括西妥昔单抗、CTX（环磷酰胺）、伊可替尼、吉非替尼、阿法替尼和厄洛替尼。所有 16 项研究均报告了总生存期（OS）的结果，其中 15 项研究还报告了无进展生存期（PFS）的结果。NMA 结果显示，6 种治疗方案的 OS 无显著差异。结果显示，厄洛替尼获得最佳 OS 的可能性最高，其次是阿法替尼、吉非替尼、伊可替尼、CTX 和西妥昔单抗，依次递减。这表明厄洛替尼获得最佳 OS 的可能性最高，而西妥昔单抗的可能性最低。NMA 结果还显示，阿法替尼、厄洛替尼和吉非替尼治疗的 PFS 均高于 CTX 治疗，差异有统计学意义。结果显示，厄洛替尼、吉非替尼、阿法替尼、西妥昔单抗和伊可替尼之间的 PFS 无显著差异。根据 PFS 指标 SUCRA 值，CTX、西妥昔单抗、伊可替尼、吉非替尼、阿法替尼和厄洛替尼依次递减，这意味着厄洛替尼获得最佳 PFS 的可能性最高，而 CTX 的可能性最低。因此，EGFR-TKI 治疗不同组织学类型的 NSCLC 时必须仔细选择。对于 EGFR 突变（+）非鳞状 NSCLC，厄洛替尼最有可能获得最佳的 OS 和 PFS，使其成为治疗方案制定的首选。
