Adjuvant therapy in completely resected, EGFR-mutant non-small cell lung cancer: a comparative analysis of treatment efficacy between EGFR-TKI and anti-PD-1/PD-L1 immunotherapy.
Adjuvant therapy in completely resected, EGFR-mutant non-small cell lung cancer: a comparative analysis of treatment efficacy between EGFR-TKI and anti-PD-1/PD-L1 immunotherapy.
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DOI：
10.1136/jitc-2023-007327
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发表时间：
2023-10
影响因子：
10.9
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中科院分区：
文献类型：
--
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IMpower010和KEYNOTE-091试验证明了化疗后辅助免疫治疗（IO）对切除的非小细胞肺癌（NSCLC）的益处，包括那些表皮生长因子受体基因（EGFR）突变的患者。同时，一些研究报道egfr -酪氨酸激酶抑制剂（EGFR-TKI）可能延长这些患者的无病生存期（DFS）。然而，目前缺乏这两种辅助治疗策略之间的正面比较。因此，我们设计了一项疗效比较分析，通过评估DFS作为主要结局，为临床决策提供信息。直接荟萃分析结果显示，EGFR-TKI降低了完全切除的NSCLC复发和/或死亡的风险（HREGFR-TKI/chemo = 0.41, 95% CI: 0.23 ~ 0.74, p=0.003），而C+IO与单独化疗相比没有显著改善DFS （HRC+IO/chemo=0.68, 95% CI: 0.31 ~ 1.50, p=0.338）。间接比较表明，EGFR-TKI与C+IO相比有延长DFS的趋势（HR EGFR-TKI/C+IO = 0.60, 95% CI: 0.23 ~ 1.61, p=0.312），而第三代TKI（第三代TKI）奥希替尼明显优于C+IO （hr3 -TKI/C+IO = 0.29, 95% CI: 0.12 ~ 0.70, p=0.006）。综上所述，对于完全切除的egfr突变型NSCLC，奥西替尼而非免疫治疗应被视为首选的辅助治疗。
The IMpower010 and KEYNOTE-091 trials have demonstrated the benefit of adjuvant immunotherapy (IO) after chemotherapy (C+IO) in resected non-small cell lung cancer (NSCLC), including those with epidermal growth factor receptor gene (EGFR) mutation. Meanwhile, several studies have reported that EGFR-tyrosine kinase inhibitor (EGFR-TKI) may prolong disease-free survival (DFS) in these patients. However, there is currently a lack of head-to-head comparison between these two adjuvant therapy strategies. Therefore, we designed a comparative analysis of their efficacy to inform clinical decision-making by assessing DFS as the primary outcome. The results of direct meta-analysis indicated that EGFR-TKI reduced the risk of recurrence and/or death in completely resected NSCLC (HREGFR-TKI/chemo = 0.41, 95% CI: 0.23 to 0.74, p=0.003), while C+IO did not significantly improve DFS compared with chemotherapy alone (HRC+IO/chemo=0.68, 95% CI: 0.31 to 1.50, p=0.338). Indirect comparison suggested that EGFR-TKI has a trend to prolong DFS compared with C+IO (HR EGFR-TKI/C+IO = 0.60, 95% CI: 0.23 to 1.61, p=0.312), while the third-generation TKI (3rd-TKI) osimertinib significantly outperformed C+IO (HR3rd-TKI/C+IO = 0.29, 95% CI: 0.12 to 0.70, p=0.006). In conclusion, osimertinib rather than immunotherapy should be regarded as the preferred adjuvant therapy in completely resected, EGFR-mutant NSCLC.
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