The efficacy and safety of erlotinib compared with chemotherapy in previously treated NSCLC: A meta-analysis

Fazong Wu; Jingjing Song; Zhongwei Zhao; Xufang Huang; Jianting Mao; Jianfei Tu; Minjiang Chen; Weiqian Chen; Shiji Fang; Liyun Zheng; Xiaoxi Fan; Fazong Wu; Jingjing Song; Zhongwei Zhao; Xufang Huang; Jianting Mao; Jianfei Tu; Minjiang Chen; Weiqian Chen; Shiji Fang; Liyun Zheng; Xiaoxi Fan

doi:10.3934/mbe.2019398

Mathematical Biosciences and Engineering

2019, Volume 16, Issue 6: 7921-7933. doi: 10.3934/mbe.2019398

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Research article Special Issues

The efficacy and safety of erlotinib compared with chemotherapy in previously treated NSCLC: A meta-analysis

1.
Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention research, Lishui Central Hospital, Lishui, Zhejiang, People’s Republic of China
2.
Department of Interventional Radiology, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People’s Republic of China

Received: 20 February 2019 Accepted: 10 July 2019 Published: 28 August 2019

BackgroundAn increasing number of patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis and develop progressive disease after receiving conventional treatments. In recent years, several novel therapies have been approved for later lines of therapy of previously treated NSCLC. Erlotinib, an EGFR tyrosine kinase inhibitor, was recommended as the second-line therapy for pre-treated patients. However, the use of erlotinib has been reported to represent different clinical effects and adverse effects.

ObjectivesThe current study was aim to investigate the efficacy and safety of erlotinib versus chemotherapy in pre-treated patients with advanced NSCLC.

MethodsElectronic databases were searched for eligible literatures updated on June 2018. Randomized-controlled trials assessing the efficacy and safety of erlotinib in pre-treated NSCLC were included, of which the main outcomes were ORR (objective response rate), PFS (progression-free survival), OS (overall survival) and AEs (adverse events). All the data were pooled with the corresponding 95% confidence interval using RevMan software. Sensitivity analyses and heterogeneity were quantitatively evaluated.

ResultsA total of 11 randomized controlled trials were included in this analysis. The group of erlotinib did not achieved benefit in progression-free survival (OR = 0.61, 95%CI = 0.33–1.12, P = 0.11), overall survival (OR = 0.98, 95%CI = 0.84–1.15, P = 0.81) as well with the objective response rate (OR = 0.77, 95%CI = 0.36–1.63, P = 0.49), respectively. In the results of subgroup analysis among the patients with EGFR wild-type, there is also no significant differences in overall survival with erlotinib (OR = 0.90, 95%CI = 0.78–1.04, P = 0.15) and progression-free survival (OR = 0.33, 95%CI = 0.09–1.18, P = 0.09). The most common treatment-related adverse events in the erlotinib group is rash (OR = 5.79, 95%CI = 2.12–15.77, P = 0.0006), and neutropenia (OR = 0.02, 95%CI = 0.01–0.10, P ≤ 0.00001) is more found in the control group. In addition, fatigue (P = 0.09) and diarrhea (P = 0.52), the difference between the two groups had no statistical significance.

ConclusionsThere was no significant difference noted with regard to efficacy and safety between erlotinib vs. chemotherapy as the later-line therapy for previously treated patients with NSCLC, even with subgroup patients who have wild-type EGFR tumors. While, erlotinib might increase the risk of rash, and decrease the risk of neutropenia, compared with the chemotherapy. Further research is needed to develop a database of all EGFR mutations and their individual impact on the differing treatments.
- NSCLC,
- erlotinib,
- pretreated patients,
- meta-analysis
Citation: Fazong Wu, Jingjing Song, Zhongwei Zhao, Xufang Huang, Jianting Mao, Jianfei Tu, Minjiang Chen, Weiqian Chen, Shiji Fang, Liyun Zheng, Xiaoxi Fan. The efficacy and safety of erlotinib compared with chemotherapy in previously treated NSCLC: A meta-analysis[J]. Mathematical Biosciences and Engineering, 2019, 16(6): 7921-7933. doi: 10.3934/mbe.2019398

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Abstract

BackgroundAn increasing number of patients with advanced non-small cell lung cancer (NSCLC) have a poor prognosis and develop progressive disease after receiving conventional treatments. In recent years, several novel therapies have been approved for later lines of therapy of previously treated NSCLC. Erlotinib, an EGFR tyrosine kinase inhibitor, was recommended as the second-line therapy for pre-treated patients. However, the use of erlotinib has been reported to represent different clinical effects and adverse effects.

ObjectivesThe current study was aim to investigate the efficacy and safety of erlotinib versus chemotherapy in pre-treated patients with advanced NSCLC.

MethodsElectronic databases were searched for eligible literatures updated on June 2018. Randomized-controlled trials assessing the efficacy and safety of erlotinib in pre-treated NSCLC were included, of which the main outcomes were ORR (objective response rate), PFS (progression-free survival), OS (overall survival) and AEs (adverse events). All the data were pooled with the corresponding 95% confidence interval using RevMan software. Sensitivity analyses and heterogeneity were quantitatively evaluated.

ResultsA total of 11 randomized controlled trials were included in this analysis. The group of erlotinib did not achieved benefit in progression-free survival (OR = 0.61, 95%CI = 0.33–1.12, P = 0.11), overall survival (OR = 0.98, 95%CI = 0.84–1.15, P = 0.81) as well with the objective response rate (OR = 0.77, 95%CI = 0.36–1.63, P = 0.49), respectively. In the results of subgroup analysis among the patients with EGFR wild-type, there is also no significant differences in overall survival with erlotinib (OR = 0.90, 95%CI = 0.78–1.04, P = 0.15) and progression-free survival (OR = 0.33, 95%CI = 0.09–1.18, P = 0.09). The most common treatment-related adverse events in the erlotinib group is rash (OR = 5.79, 95%CI = 2.12–15.77, P = 0.0006), and neutropenia (OR = 0.02, 95%CI = 0.01–0.10, P ≤ 0.00001) is more found in the control group. In addition, fatigue (P = 0.09) and diarrhea (P = 0.52), the difference between the two groups had no statistical significance.

ConclusionsThere was no significant difference noted with regard to efficacy and safety between erlotinib vs. chemotherapy as the later-line therapy for previously treated patients with NSCLC, even with subgroup patients who have wild-type EGFR tumors. While, erlotinib might increase the risk of rash, and decrease the risk of neutropenia, compared with the chemotherapy. Further research is needed to develop a database of all EGFR mutations and their individual impact on the differing treatments.

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