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Review
. 2023 Feb 13;21(1):45.
doi: 10.1186/s12957-023-02925-x.

Epidermal growth factor receptor inhibitors as adjuvant treatment for patients with resected non-small cell lung cancer harboring EGFR mutation: a meta-analysis of randomized controlled clinical trials

Ning Zhao #  1 , Zhuo-Peng Wu #  1 , Jie Yang  1 , Wei-Neng Feng  2 , Sheng-Li Yang  1 , Ying Luo  3 , Jun Ye  1 , Fei Wang  1 , Xiao-Wen Zhang  1 , Ye Xiao  1 , Ling-Ling Wu  1 , Wei-Quan Gu  4
Affiliations
Review

Epidermal growth factor receptor inhibitors as adjuvant treatment for patients with resected non-small cell lung cancer harboring EGFR mutation: a meta-analysis of randomized controlled clinical trials

Ning Zhao et al. World J Surg Oncol. .

Abstract

Background: The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) is still under investigation as adjuvant treatment for early-stage disease. Here, we performed a meta-analysis to evaluate the efficacy of adjuvant EGFR-TKI versus non-EGFR-TKI treatment in patients with completely resected non-small cell lung cancer (NSCLC) harboring EGFR mutation.

Methods: Two investigators independently extracted data from databases. A meta-analysis was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol was registered in PROSPERO (ID: CRD42022316481). The primary outcome was disease-free survival (DFS) in patients with EGFR mutation, measured as the hazard ratio (HR). Other outcomes (of subgroup analyses) included overall survival (OS) and DFS.

Results: After the systematic screening, eight studies with a total of 3098 patients with stage IB-IIIA NSCLC were included. The results show that in patients with EGFR mutation, the DFS in the adjuvant EGFR-TKI group was significantly superior to that in the control group, with a HR of 0.47 (95% confidence interval [CI]: 0.30-0.74; P = 0.001). In subgroup analyses of DFS, the benefit was observed in the EGFR-TKI group versus the chemotherapy group (HR 0.50, 95% CI 0.30-0.84; P = 0.009), the EGFR-TKI combined with chemotherapy group versus the chemotherapy group (HR 0.37, 95% CI 0.16-0.85; P = 0.02), and in stage IIA-IIIA NSCLC (HR 0.45, 95% CI 0.27-0.74; P = 0.002). However, the benefit of DFS did not translate into improved OS in the whole population (HR 0.79, 95% CI 0.54-1.14; P = 0.20).

Conclusion: EGFR-TKIs prolonged DFS but not OS in patients with completely resected stage II-IIIA NSCLC harboring EGFR mutation. Longer follow-ups and new clinical trials that can result in changes in clinical practice are needed.

Keywords: Adjuvant treatment; EGFR Mutation; EGFR-TKI; Meta-analysis; Non-small cell lung cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of selection of studies to include or exclude
Fig. 2
Fig. 2
Risk of bias for each included study
Fig. 3
Fig. 3
Forest plot of DFS in EGFR-TKI- vs. non-EGFR-TKI-treated patients
Fig. 4
Fig. 4
Forest plot of DFS in the subgroup analysis of EGFR-mutant patients
Fig. 5
Fig. 5
Forest plot of OS in EGFR-TKI- vs. non-EGFR-TKI-treated patients
See this image and copyright information in PMC

References

    1. Arriagada R, Auperin A, Burdett S, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet. 2010;375(9722):1267–1277. doi: 10.1016/S0140-6736(10)60059-1. - DOI - PMC - PubMed
    1. Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: non-small cell lung cancer, Version 1.2020. J Natl Compr Canc Netw. 2019;17(12):1464–1472. doi: 10.6004/jnccn.2019.0059. - DOI - PubMed
    1. Burdett S, Pignon JP, Tierney J, et al. Adjuvant chemotherapy for resected early-stage non-small cell lung cancer. Cochrane Database Syst Rev. 2015;3:D11430. - PMC - PubMed
    1. Wakelee HA, Dahlberg SE, Keller SM, et al. Adjuvant chemotherapy with or without bevacizumab in patients with resected non-small-cell lung cancer (E1505): an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2017;18(12):1610–1623. doi: 10.1016/S1470-2045(17)30691-5. - DOI - PMC - PubMed
    1. Zhang X, Jiang Y, Yu H, et al. A comprehensive study on the oncogenic mutation and molecular pathology in Chinese lung adenocarcinoma patients. World J Surg Oncol. 2020;18(1):172. doi: 10.1186/s12957-020-01947-z. - DOI - PMC - PubMed

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