The Efficacy of Synchronous Combination of Chemotherapy and EGFR TKIs for the First-Line Treatment of NSCLC: A Systematic Analysis.
The Efficacy of Synchronous Combination of Chemotherapy and EGFR TKIs for the First-Line Treatment of NSCLC: A Systematic Analysis.
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DOI：
10.1371/journal.pone.0135829
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Cao B
中科院分区：
文献类型：
--
作者：
Yan H;Li H;Li Q;Zhao P;Wang W;Cao B
化疗与表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）联合治疗已成为目前非小细胞肺癌（NSCLC）治疗的热点问题。本系统评价旨在比较这两种疗法同步联合 EGFR TKI 或单独化疗治疗晚期 NSCLC 的疗效和安全性。检索了EMBASE、PubMed、Cochrane图书馆对照试验中央登记库（CENTRAL）、中国生物医学文献数据库（CNKI）和会议摘要。选择 II/III 期随机对照试验，其中晚期 NSCLC 患者被随机分配接受同步模式 EGFR TKI 和化疗联合治疗与 EGFR TKI 或单独化疗治疗。共有六项随机对照试验（RCT），包括 4675 名患者参与了系统评价。 Meta分析显示化疗与EGFR TKI同步联合组并未达到满意的效果；与单药治疗相比，总生存期（OS）、进展时间（TTP）和客观缓解率（ORR）没有显着差异（OS：HR = 1.05，95% CI = 0.98-1.12；TTP：HR = 0.94，95% CI = 0.89-1.00；ORR：RR = 1.07，95% CI = 0.98–1.17），与单独使用 EGFR TKI 相比，OS 和无进展生存期 (PFS) 无显着差异（OS：HR = 1.10，95% CI = 0.83–1.46；PFS：HR = 0.86，95% CI = 0.67–1.10）。与化疗相比，接受同步联合治疗的患者 3/4 级贫血（RR = 1.40，95% CI = 1.10–1.79）和皮疹（RR = 7.43，95% CI = 4.56–12.09）的发生率增加，3/4 级贫血（RR = 6.71，95% CI = 1.25–35.93）和与 EGFR TKI 单药治疗相比，疲劳（RR = 9.60，95% CI = 2.28–40.86）。化疗与TKI同步联合治疗NSCLC一线治疗并不优于单独化疗或EGFR TKI。
The combination of chemotherapy and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) currently has become the hotspot issue in the treatment of non-small lung cancer (NSCLC). This systematic review was conducted to compare the efficacy and safety of the synchronous combination of these two treatments with EGFR TKIs or chemotherapy alone in advanced NSCLC. EMBASE, PubMed, the Central Registry of Controlled Trials in the Cochrane Library (CENTRAL), Chinese biomedical literature database (CNKI) and meeting summaries were searched. The Phase II/III randomized controlled trials were selected by which patients with advanced NSCLC were randomized to receive a combination of EGFR TKIs and chemotherapy by synchronous mode vs. EGFR TKIs or chemotherapy alone. A total of six randomized controlled trials (RCTs) including 4675 patients were enrolled in the systematic review. The meta-analysis demonstrated that the synchronous combination group of chemotherapy and EGFR TKIs did not reach satisfactory results; there was no significant difference in overall survival (OS), time to progression (TTP) and objective response rate (ORR), compared with monotherapy (OS: HR = 1.05, 95%CI = 0.98–1.12; TTP: HR = 0.94, 95%CI = 0.89–1.00; ORR: RR = 1.07, 95%CI = 0.98–1.17), and no significant difference in OS and progression-free survival (PFS), compared with EGFR TKIs alone (OS: HR = 1.10, 95% CI = 0.83–1.46; PFS: HR = 0.86, 95% CI = 0.67–1.10). The patients who received synchronous combined therapy presented with increased incidences of grade 3/4 anemia (RR = 1.40, 95% CI = 1.10–1.79) and rash (RR = 7.43, 95% CI = 4.56–12.09), compared with chemotherapy, grade 3/4 anemia (RR = 6.71, 95% CI = 1.25–35.93) and fatigue (RR = 9.60, 95% CI = 2.28–40.86) compared with EGFR TKI monotherapy. The synchronous combination of chemotherapy and TKIs is not superior to chemotherapy or EGFR TKIs alone for the first-line treatment of NSCLC.