PMID- 31147837
OWN - NLM
STAT- MEDLINE
DCOM- 20210331
LR  - 20210331
IS  - 1532-2807 (Electronic)
IS  - 1219-4956 (Linking)
VI  - 26
IP  - 2
DP  - 2020 Apr
TI  - The Effect of Next-Generation TKI in Non-Small Cell Lung Cancer after Failure of 
      First-Line Treatment: a Meta-Analysis.
PG  - 1137-1143
LID - 10.1007/s12253-019-00669-2 [doi]
AB  - Resistance develops against first-generation tyrosine kinase inhibitors (TKIs), 
      which target the epidermal growth factor receptor (EGFR), after a while for 
      non-small-cell lung cancer (NSCLC). Recently, researchers have developed specific 
      inhibitors against them. Among those inhibitors, next-generation EGFR-TKIs have 
      gained prominence due to the greater efficacy and more favorable tolerability. 
      Today, the efficacy of next-generation EGFR-TKIs in patients with advanced NSCLC 
      after failure on first-generation EGFR-TKIs still remains under investigation. 
      The aim of this meta-analysis was to systematically assess the efficacy and 
      safety profiles of next-generation EGFR-TKIs in advanced NSCLC after failure on 
      first-generation EGFR-TKIs. We performed a comprehensive search of the several 
      electronic databases to September, 2018 to identify clinical trials. The primary 
      endpoint was overall survival (OS), progression-free survival (PFS), disease 
      controlled rate (DCR), objective response rate (ORR), and adverse events (AEs). 
      Severe adverse events (AEs) (grade >/= 3) based on the EGFR-TKIs were analysed. 
      Odds Ratio (OR) along with 95% confidence interval (95% CI) were utilized for the 
      main outcome analysis. In total, we had 3 randomized controlled trials in this 
      analysis. The group of next-generation EGFR-TKIs was significantly improved PFS 
      (OR = 0.34,95%CI = 0.29-0.40, P < 0.00001), as well with the ORR 
      (OR = 10.48,95%CI = 3.87-28.34, P < 0.00001) and DCR 
      (OR = 6.03,95%CI = 4.41-8.25, P < 0.00001), respectively. However, there is no 
      significant difference in overall survival with next-generation EGFR-TKIs 
      (OR = 1.05,95%CI = 0.85-1.31, P = 0.66). While, the OR for the treatment-related 
      AEs of grade 3 or 4 (diarrhoea, rash/acne, nausea, vomiting, anemia) between the 
      patients who received next-generation EGFR-TKIs and chemotherapy did not show 
      safety benefit (P>0.05). Next-generation EGFR-TKIs was shown to be the better 
      agent to achieve higher response rate and the longer PFS in NSCLC patients as the 
      later-line therapy for previously treated patients with first-generation 
      EGFR-TKIs. While, the benefit of the OS and safety compared with the chemotherapy 
      did not achieved. Further research is needed to develop a database of all EGFR 
      mutations and their individual impact on the differing treatments.
FAU - Zhang, Lei
AU  - Zhang L
AD  - Department of Oncology, The Second Hospital of Shanxi Medical University, No. 382 
      Wuyi Road, Xinghualing District, Taiyuan, 030013, Shanxi, China.
FAU - Ren, Hong-Wei
AU  - Ren HW
AD  - Department of Oncology, The Second Hospital of Shanxi Medical University, No. 382 
      Wuyi Road, Xinghualing District, Taiyuan, 030013, Shanxi, China.
FAU - Wu, Qi-Long
AU  - Wu QL
AD  - Department of Oncology, The Second Hospital of Shanxi Medical University, No. 382 
      Wuyi Road, Xinghualing District, Taiyuan, 030013, Shanxi, China.
FAU - Wu, Yan-Juan
AU  - Wu YJ
AD  - Department of Cardio-Thoracic Surgery, The Second Hospital of Shanxi Medical 
      University, Taiyuan, Shanxi, China.
FAU - Song, Xiang
AU  - Song X
AUID- ORCID: 0000-0001-5111-9229
AD  - Department of Oncology, The Second Hospital of Shanxi Medical University, No. 382 
      Wuyi Road, Xinghualing District, Taiyuan, 030013, Shanxi, China. 
      zhanglei790114@sina.com.
LA  - eng
GR  - No. 201301013/Mission of Scientific Research Project of Shanxi Provincial 
      Department of Health/
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20190531
PL  - Switzerland
TA  - Pathol Oncol Res
JT  - Pathology oncology research : POR
JID - 9706087
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Protein Kinase Inhibitors)
SB  - IM
MH  - Antineoplastic Agents/*therapeutic use
MH  - Carcinoma, Non-Small-Cell Lung/*drug therapy
MH  - Humans
MH  - Lung Neoplasms/*drug therapy
MH  - Protein Kinase Inhibitors/*therapeutic use
MH  - Salvage Therapy/methods
OTO - NOTNLM
OT  - EGFR-TKIs
OT  - Meta-analysis
OT  - NSCLC
OT  - Pretreated patients
EDAT- 2019/05/31 06:00
MHDA- 2021/04/01 06:00
CRDT- 2019/06/01 06:00
PHST- 2018/11/06 00:00 [received]
PHST- 2019/05/20 00:00 [accepted]
PHST- 2019/05/31 06:00 [pubmed]
PHST- 2021/04/01 06:00 [medline]
PHST- 2019/06/01 06:00 [entrez]
AID - 10.1007/s12253-019-00669-2 [pii]
AID - 10.1007/s12253-019-00669-2 [doi]
PST - ppublish
SO  - Pathol Oncol Res. 2020 Apr;26(2):1137-1143. doi: 10.1007/s12253-019-00669-2. Epub 
      2019 May 31.