PMID- 31335695
OWN - NLM
STAT- MEDLINE
DCOM- 20190802
LR  - 20231013
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 29
DP  - 2019 Jul
TI  - Epidermal growth factor receptor tyrosine kinase inhibitors combined with 
      thoracic radiotherapy or chemoradiotherapy for advanced or metastatic non-small 
      cell lung cancer: A systematic review and meta-analysis of single-arm trials.
PG  - e16427
LID - 10.1097/MD.0000000000016427 [doi]
LID - e16427
AB  - BACKGROUND: Preclinical in vitro experiments demonstrated that epidermal growth 
      factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) might have synergistic 
      effect in combination with radiotherapy on Non-small cell lung cancer (NSCLC), 
      but the clinical trials showed inconsistence results in NSCLC patients with EGFR 
      status unknow or mutations. This study aimed to determine if added TKIs to 
      Thoracic radiotherapy (TRT) improve primary disease response rate (RR) and 
      survival outcomes in advanced or metastatic NSCLC. METHODS: We searched MEDLINE, 
      EMBASE, and Cochrane Library from January 2000 to December 2017 for eligible 
      studies where patients received concurrent EGFR TKIs and TRT or CRT. Concerned 
      outcomes were primary tumor RR, overall survival (OS), and adverse events (AEs). 
      The meta-analysis was performed using Stata software (version 12.0). Random 
      effects models were used to pool outcomes across studies. Sensitivity analysis 
      was performed to determine if the results would be different. RESULTS: We found 
      16 prospective clinical trials with mature results for meta-analyses. Twelve 
      studies including 446 patients reported the RR and survival outcomes of TRT 
      combined TKIs. The CR, PR, SD, and PD, respectively, were 0.06 (95% CI 0.03-0.09, 
      I = 0%), 0.44 (95% CI 0.38-0.49, I = 64.9%), 0.29 (95% CI 0.24-0.34, I = 78.4%), 
      and 0.15 (95% CI 0.11-0.19, I = 84.2%). One- and 2-year OS, respectively, were 
      0.52 (95% CI 0.44-0.60, I = 38.8%) and 0.26 (95% CI 0.18-0.33, I = 0%). Four 
      studies including 182 patients reported the RR and survival outcomes of CRT 
      combined TKIs. The pooled CR, PR, SD, and PD, respectively, were 0.12 (95% CI 
      0.02-0.22, I = 69.1%), 0.41 (95% CI 0.27-0.55, I71.6%), 0.31 (95% CI 0.16-0.46, 
      I = 79%), and 0.14 (95% CI -0.01-0.30, I = 87.8%). Only 1 study reported the 
      survival event rate, 1- and 2-year OS, respectively, were 0.83 (95% CI 0.71-0.94) 
      and 0.67 (95% CI 0.54-0.81). There were not severe adverse events (SAEs) reported 
      either TRT combined TKIs or CRT combined TKIs. CONCLUSION: There is evidence, 
      albeit of low quality, that added the TKIs to TRT or CRT may improve RR and 
      survival outcomes in patients with EGFR mutant status unknown advanced or 
      metastatic NSCLC relative to other studies of TKIs alone, TRT alone or CRT.
FAU - Liu, Ruifeng
AU  - Liu R
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
FAU - Wei, Shihong
AU  - Wei S
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
FAU - Zhang, Qiuning
AU  - Zhang Q
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
FAU - Zhang, Xueliang
AU  - Zhang X
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
FAU - Luo, Hongtao
AU  - Luo H
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
FAU - Tian, Jinhui
AU  - Tian J
AD  - Center of Evidence Based Medicine, Lanzhou University, Lanzhou.
FAU - Li, Yi
AU  - Li Y
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Hebei provincial chest Hospital, Shijiazhuang, PR China.
FAU - Ge, Long
AU  - Ge L
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Center of Evidence Based Medicine, Lanzhou University, Lanzhou.
FAU - Wang, Xiaohu
AU  - Wang X
AD  - The First Clinical Medical College of Lanzhou University.
AD  - Radiotherapy Oncology Department, Gansu Provincial Cancer Hospital.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Protein Kinase Inhibitors)
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy/pathology/radiotherapy
MH  - Chemoradiotherapy/*methods
MH  - ErbB Receptors/*antagonists & inhibitors
MH  - Humans
MH  - *Lung Neoplasms/drug therapy/pathology/radiotherapy
MH  - Neoplasm Staging
MH  - Protein Kinase Inhibitors/*pharmacology
MH  - Treatment Outcome
PMC - PMC6708798
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2019/07/25 06:00
MHDA- 2019/08/03 06:00
PMCR- 2019/07/19
CRDT- 2019/07/24 06:00
PHST- 2019/07/24 06:00 [entrez]
PHST- 2019/07/25 06:00 [pubmed]
PHST- 2019/08/03 06:00 [medline]
PHST- 2019/07/19 00:00 [pmc-release]
AID - 00005792-201907190-00030 [pii]
AID - MD-D-18-07518 [pii]
AID - 10.1097/MD.0000000000016427 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Jul;98(29):e16427. doi: 10.1097/MD.0000000000016427.