EGFR+ NSCLC: adding targeted therapy to ACT prolongs survival

  • Lung Cancer
  • 1 Aug 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Adding epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) to adjuvant chemotherapy (ACT) can prolong OS and DFS in patients with resected EGFR mutation-positive NSCLC.

Why this matters

  • Optimal therapy for resected NSCLC remains controversial.

Study design

  • Meta-analysis of 11 clinical trials involving treatment with EGFR-TKIs after NSCLC resection (N=1152), calculating pooled OR for DFS and OS.
  • Funding: National Natural Science Foundation of China; Key Research and Development Plan of Shandong, China.

Key results

  • Adjuvant EGFR-TKIs±chemotherapy extended OS (OR, 0.63; P=.004 [heterogeneity high, I2=61%; P=.008]) and DFS (OR, 0.56; 95% CI, 0.43-0.72; P<.00001>2=37%; P=.10]) relative to no EGFR-TKIs (placebo/ACT).
    • In subanalysis, monotherapy with EGFR-TKIs extended DFS (OR, 0.67; P=.04 [I2=0%; P=.56]), but not OS (P=.30), vs chemotherapy alone.
  • Adding EGFR-TKIs to ACT significantly prolonged DFS (OR, 0.48; P<.00001>2=15%; P=.29]) and OS (OR, 0.50; P=.003 [I2=57%; P=.05]) relative to chemotherapy alone.
  • Treatment with EGFR-TKIs was associated with fewer severe adverse events than chemotherapy (OR, 0.22; P<.00001>2=22%; P=.28]).

Limitations

  • Few studies compare EGFR-TKIs monotherapy vs chemotherapy.
  • OS benefit was primarily driven by 2 studies involving only stage III patients.

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