Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Versus Placebo as Maintenance Therapy for Advanced Nonsmall-cell Lung Cancer: A Meta-analysis of Randomized Controlled Trials

Background: Use of epidermal growth factor receptor inhibitors (EGFR-TKIs ) is now standard for nonsmall-cell lung cancer (NSCLC). However, the effects of EGFR-TKIs in maintenance therapy for advancedNSCLC patients are still unclear. The preent meta-analysis was performed to examine pooled data of randomizedcontrol trials (RCT) where EGFR-TKIs were compared against placebo in maintenance regimens for patientswith advanced NCSLC to quantify potential benefits and determine safety.
Methods: Several data bases weresearched, including PubMed, EMBASE and CENTRAL, and we performed an internet search of conferenceliterature. The endpoints were objective response rates (ORR), progression-free survival (PFS) and overallsurvival (OS). We performed a meta-analysis of the published data, using Comprehensive Meta Analysis software(Version 2.0). with a fixed effects model and an additional random effects model, when applicable. The resultsof the meta-analysis are expressed as hazard ratios (HRs) or risk ratios (RRs), with their corresponding 95%confidence intervals (95%CIs).
Results: The final analysis included six trials, covering 3,758 patients. Comparedwith placebo, EGFR-TKIs maintenance therapy improved ORR and PFS for patients with advanced NSCLC, thedifference being statistically significant (P<0.05), but proved unable to prolong patients’ OS. The main adversereactions were diarrhea and rashes.
Conclusion: EGFR-TKIs demonstrated encouraging efficacy, safety andsurvival when delivered as maintenance therapy for patients with advanced NSCLC after first-line chemotherapy,especially for the patients who had adenocarcinomas, were female, non-smokers and patients with EGFR genemutations.