Efficacy of targeted agents in the treatment of elderly patients with advanced non-small-cell lung cancer: a systematic review and meta-analysis

Abstract

Purpose: The efficacy of targeted agents (TAs) in the treatment of elderly patients with advanced non-small-cell lung cancer (NSCLC) remains controversial. We aimed to assess the efficacy of TAs in the treatment of advanced NSCLC in this setting.

Materials and methods: Relevant trials were identified by searching electronic databases and conference meetings. Prospective randomized controlled trials assessing chemotherapies with or without TAs in elderly patients with advanced NSCLC were included. Outcomes of interest included overall survival (OS) and progression-free survival (PFS) in elderly patients with advanced NSCLC.

Results: A total of 4,093 elderly patients from 17 randomized controlled trials were included for analysis. The addition of TAs to chemotherapy significantly improved PFS (hazard ratio [HR] 0.85, 95% confidence interval [CI]: 0.75-0.96, P=0.01) when compared to chemotherapy alone. There was also a tendency to improve OS in the combination groups (HR 0.92, 95% CI: 0.85-1.01, P=0.064). Subgroup analysis based on treatment line indicated that TAs plus chemotherapy as first-line chemotherapy in elderly patients with advanced NSCLC significantly improved PFS (HR 0.80, 95% CI: 0.68-0.95, P=0.01) and OS (HR 0.91, 95% CI: 0.83-0.99, P=0.037), while the use of TA-containing regimens as second-line therapy in these patients did not significantly improve PFS (HR 0.91, 95% CI: 0.75-1.10, P=0.33) and OS (HR 1.04, 95% CI: 0.81-1.33, P=0.77) in comparison with chemotherapy alone. No publication bias was detected by Begg's and Egger's tests for OS.

Conclusion: The findings of this study suggest that the addition of TAs to first-line chemotherapy in elderly patients with advanced NSCLC offers an improved PFS and OS. Further trials are recommended to clearly investigate the efficacy of adding specific TAs to first-line chemotherapy for advanced NSCLC in this setting.

Keywords: elderly; meta-analysis; non-small-cell lung cancer; randomized controlled trials; targeted agents.

Figure 1

Studies eligible for inclusion in the meta-analysis. Abbreviation: TA, targeted agent.

Figure 2

Fixed-effects model of hazard ratio (95% CI) of OS associated with chemotherapy with or without TAs. Notes: Thatcher et al, divided older patients into two groups (60–70 and >70) within their study, as both groups consist of patients with NSCLC treated with targeted agents. Thus, the efficacy of targeted agents in these two groups are different so they are displayed separately. Abbreviations: CI, confidence interval; OS, overall survival; TA, targeted agent.

Figure 3

Random-effects model of hazard ratio (95% CI) of PFS associated with chemotherapy with or without TAs. Abbreviations: CI, confidence interval; PFS, progression-free survival; TA, targeted agent.