Skip Navigation LinksHome > June 2014 - Volume 9 - Issue 6 > Meta-Analysis of First-Line Therapies in Advanced Non–Small-...
Journal of Thoracic Oncology:
doi: 10.1097/JTO.0000000000000156
Original Articles

Meta-Analysis of First-Line Therapies in Advanced Non–Small-Cell Lung Cancer Harboring EGFR-Activating Mutations

Haaland, Benjamin PhD*†; Tan, Pui San MPharm; de Castro, Gilberto MD, PhD§; Lopes, Gilberto MD, MBA, FAMS‖¶

Collapse Box

Abstract

Introduction:

Tyrosine kinase inhibitors gefitinib, erlotinib, and afatinib have been compared with chemotherapy as first-line therapies for patients with advanced non–small-cell lung cancer harboring epidermal growth factor receptoractivating mutations. This meta-analysis compares gefitinib, erlotinib, afatinib, and chemotherapy.

Methods:

Literature search was performed using relevant keywords. Direct and indirect meta-estimates were generated using log-linear mixed-effects models, with random effects for study. Study-to-study heterogeneity was summarized using I2 statistics and predictive intervals (PIs).

Results:

Literature search yielded eight randomized phase 3 clinical trials comparing gefitinib, erlotinib, or afatinib with chemotherapy as first-line therapy in patients with advanced non–small-cell lung cancer during the last 5 years. Hazard ratio meta-estimates for progression-free survival were for gefitinib versus chemotherapy 0.44 (95% confidence interval [CI] 0.31–0.63; 95% PI, 0.22–0.88), erlotinib versus chemotherapy 0.25 (95% CI, 0.15–0.42; 95% PI, 0.11–0.55), afatinib versus chemotherapy 0.44 (95% CI, 0.26–0.75; 95% PI, 0.20–0.98), erlotinib versus gefitinib 0.57 (95% CI, 0.30–1.08; 95% PI, 0.24–1.36), afatinib versus gefitinib 1.01 (95% CI, 0.53–1.92; 95% PI, 0.41–2.42), and erlotinib versus afatinib 0.56 (95% CI, 0.27–1.18; 95% PI, 0.22–1.46). Results for overall response rate and disease control rate were similar. There was no evidence that gefitinib, erlotinib, or afatinib improved overall survival compared with chemotherapy.

Conclusion:

Gefitinib, erlotinib, and afatinib out-performed chemotherapy in terms of progression-free survival, overall response rate, and disease control rate. Differences among gefitinib, erlotinib, and afatinib were not statistically significant.

Copyright © 2014 by the International Association for the Study of Lung Cancer

Login

Article Tools

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.

Other Ways to Connect

Twitter
twitter.com/JTOonline

 



Visit JTO.org on your smartphone. Scan this code (QR reader app required) with your phone and be taken directly to the site.

 For additional oncology content, visit LWW Oncology Journals on Facebook.