Unité d'Oncologie et Gériatrie, HUPSSD, Hôpital René Muret, AP-HP, Sevran, France.
Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Expert Rev Anticancer Ther. 2024 Aug;24(8):775-780. doi: 10.1080/14737140.2024.2362889. Epub 2024 Jun 3.
A tyrosine-kinase inhibitor (TKI) is indicated as a first-line treatment for patients with non-small-cell lung cancer (NSCLC) harboring an epidermal growth-factor - receptor () mutation. Chemotherapy (ChT) given in combination with an EGFR-TKI in this setting is of interest.
We conducted a meta-analysis of phase III randomized trials comparing EGFR-TKI + ChT vs. EGFR-TKI alone as first-line therapy for advanced NSCLC harboring an activating mutation.
Three studies evaluated gefitinib + ChT (NEJ009, GAP-Brain, and Noronha et al.) and another evaluated osimertinib + ChT (FLAURA-2). Those four eligible studies included 1413 patients with non-squamous NSCLCs, 826 (58%) with an exon-19 deletion (ex19del) and 541 (38%) with . The EGFR-TKI + ChT combination was significantly associated with prolonged PFS (hazard ratio [HR]: 0.52 [95% confidence interval (CI): 0.45-0.59]; < 0.0001) and OS (HR: 0.69 [0.52-0.93]; = 0.01). PFS was particularly improved for patients with brain metastases (HR: 0.41[0.33-0.51]; < 0.00001).
For patients with untreated, advanced, -mutated NSCLCs, the EGFR-TKI + ChT combination, compared to EGFR-TKI alone, was associated with significantly prolonged PFS and OS. However, further studies are needed to identify which patients will benefit the most from the combination.
PROSPERO CRD42024508055.
一种酪氨酸激酶抑制剂（TKI）被指征用于携带表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者的一线治疗。在这种情况下，联合使用化疗（ChT）和 EGFR-TKI 具有一定的研究价值。
我们对比较 EGFR-TKI+ChT 与 EGFR-TKI 单药一线治疗携带激活突变的晚期 NSCLC 的 III 期随机试验进行了荟萃分析。
有三项研究评估了吉非替尼+ChT（NEJ009、GAP-Brain 和 Noronha 等人），另有一项研究评估了奥希替尼+ChT（FLAURA-2）。这四项合格研究纳入了 1413 例非鳞状 NSCLC 患者，其中 826 例（58%）存在外显子 19 缺失（ex19del），541 例（38%）存在 。EGFR-TKI+ChT 联合治疗与 PFS（风险比[HR]：0.52[95%置信区间（CI）：0.45-0.59]； < 0.0001）和 OS（HR：0.69[0.52-0.93]； = 0.01）的显著延长相关。对于存在脑转移的患者，PFS 得到了特别改善（HR：0.41[0.33-0.51]； < 0.00001）。
对于未经治疗的、晚期、突变的 NSCLC 患者，与 EGFR-TKI 单药治疗相比，EGFR-TKI+ChT 联合治疗与 PFS 和 OS 的显著延长相关。然而，还需要进一步的研究来确定哪些患者将从联合治疗中获益最大。
PROSPERO CRD42024508055。
