NSCLC: adding anti-angiogenic drug to EGFR-TKIs yields better PFS

  • JNCI Cancer Spectr

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) combined with an antiangiogenic drug offered significantly better PFS in patients with EGFR-mutated NSCLC compared with EGFR-TKIs alone, although the incidence of grade ≥3 adverse events (AEs) was significantly greater.

Why this matters

  • Previous studies comparing combination therapy with monotherapy yielded conflicting results.

Study design

  • Systematic review and meta-analysis of 5 RCTs of EGFR-TKIs alone or with an antiangiogenic drug in patients with advanced NSCLC.
  • Network meta-analysis (NMA) of 10 RCTs of first-generation EFGR-TKIs alone vs an experimental therapy (first-generation EGFR-TKI plus an antiangiogenic drug, first-generation EGFR-TKI plus chemotherapy; or second- or third-generation EGFR-TKI alone) in patients with advanced NSCLC.
  • Funding: None.

Key results

  • Combination therapy was associated with significantly better PFS than EGFR-TKI alone (pooled HR, 0.59; 95% CI, 0.51-0.69), but there was no difference in OS.
  • Median PFS:
    • 17.8 (95% CI, 16.5-19.3) months for combination therapy.
    • 11.7 (95% CI, 11.1-12.7) months for EGFR-TKI alone.
  • Combination therapy was associated with significantly higher rate of grade ≥3 AEs than monotherapy:
    • Relative risk, 1.72 (95% CI, 1.43-2.06).
  • NMA found all experimental therapies offered better PFS than first-generation EFGR-TKI alone.
  • No difference in PFS among the 3 experimental therapies.

Limitations

  • None included.