PMID- 32714857
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231103
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 10
DP  - 2020
TI  - Efficacy and Safety of Epidermal Growth Factor Receptor (EGFR) Inhibitors Plus 
      Antiangiogenic Agents as First-Line Treatments for Patients With Advanced 
      EGFR-Mutated Non-small Cell Lung Cancer: A Meta-Analysis.
PG  - 904
LID - 10.3389/fonc.2020.00904 [doi]
LID - 904
AB  - Background: Tyrosine kinase inhibitors (TKIs) are standard treatment options for 
      non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) 
      mutations. Increasing clinical investigations have explored the value of 
      EGFR-TKIs plus antiangiogenic drugs as the first-line treatment for EGFR-mutated 
      NSCLC. Methods: We systematically searched PubMed, Cochrane Library, and EMBASE 
      for randomized controlled trials (RCTs) investigating EGFR-TKIs administered with 
      or without antiangiogenic agents for advanced EGFR-mutated NSCLC. The latest RCT 
      that was presented orally at the 2019 European Society for Medical Oncology 
      Congress was obtained online. The endpoints included progression-free survival 
      (PFS), overall survival (OS), objective response rate (ORR), disease control 
      rates (DCRs), and grade 3 or higher adverse events (AEs). Results: We included 
      seven articles on five trials with 1,226 patients. The interventions for the 
      experimental group were the first-generation EGFR-TKI erlotinib combined with 
      bevacizumab (four studies) or ramucirumab (one study), and erlotinib monotherapy 
      (four studies) or erlotinib plus placebo (one study) for the control group. All 
      studies reached their primary study endpoints (i.e., PFS). Compared to erlotinib 
      monotherapy, erlotinib plus antiangiogenic agents remarkably prolonged PFS 
      [hazard ratio (HR) = 0.59, 95% confidence interval (CI) = 0.51-0.69, P = 0.000]; 
      however, ORR, DCR, and OS were similar between the two groups. The overall grade 
      3-5 AEs increased in combination group (OR = 5.772, 95% CI = 2.38-13.94, P = 
      0.000), particularly the incidence of diarrhea (OR = 2.51, 95% CI = 1.21-5.23, P 
      = 0.014), acneiform (OR = 1.815, 95% CI = 1.084-3.037, P = 0.023), hypertension 
      (OR = 6.77, 95% CI = 3.62-12.66, P = 0.000), and proteinuria (OR = 13.48, 95% CI 
      = 4.11-44.22, P = 0.000). Additionally, subgroup analysis demonstrated that Asian 
      patients could significantly benefit from combination therapy (HR = 0.59, 95% CI 
      = 0.50-0.69, P = 0.000). Patients with exon 19 deletions (HR = 0.61, 95% CI = 
      0.49-0.75, P = 0.000) and 21 Leu858Arg mutations (HR = 0.59, 95% CI = 0.47-0.73, 
      P = 0.000) had almost equivalent PFS benefits when treated with double-blocking 
      therapy. Patients with brain metastases at baseline in the combination group had 
      a trend toward better PFS (HR = 0.55, 95% CI = 0.30-1.01, P = 0.001). 
      Conclusions: Erlotinib plus bevacizumab or ramucirumab in EFGR-mutated NSCLC 
      first-line setting yielded remarkable PFS benefits; however, this was accompanied 
      by higher AEs. Epidermal growth factor receptor-TKI plus antiangiogenic agent 
      therapy may be considered a new option for advanced EGFR-mutated NSCLC patients.
CI  - Copyright (c) 2020 Chen, Chen, Yu and Cui.
FAU - Chen, Fei
AU  - Chen F
AD  - Cancer Center, The First Hospital of Jilin University, Changchun, China.
FAU - Chen, Naifei
AU  - Chen N
AD  - Cancer Center, The First Hospital of Jilin University, Changchun, China.
FAU - Yu, Yu
AU  - Yu Y
AD  - Cancer Center, The First Hospital of Jilin University, Changchun, China.
FAU - Cui, Jiuwei
AU  - Cui J
AD  - Cancer Center, The First Hospital of Jilin University, Changchun, China.
LA  - eng
PT  - Systematic Review
DEP - 20200625
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC7344312
OTO - NOTNLM
OT  - EGFR mutation
OT  - angiogenesis inhibitors
OT  - anti-VEGF
OT  - epidermal growth factor receptor inhibitors
OT  - first line
OT  - meta-analysis
OT  - non-small cell lung cancer
OT  - targeted treatment
EDAT- 2020/07/28 06:00
MHDA- 2020/07/28 06:01
PMCR- 2020/01/01
CRDT- 2020/07/28 06:00
PHST- 2020/03/07 00:00 [received]
PHST- 2020/05/11 00:00 [accepted]
PHST- 2020/07/28 06:00 [entrez]
PHST- 2020/07/28 06:00 [pubmed]
PHST- 2020/07/28 06:01 [medline]
PHST- 2020/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2020.00904 [doi]
PST - epublish
SO  - Front Oncol. 2020 Jun 25;10:904. doi: 10.3389/fonc.2020.00904. eCollection 2020.