PMID- 34490338
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210908
IS  - 2296-875X (Print)
IS  - 2296-875X (Electronic)
IS  - 2296-875X (Linking)
VI  - 8
DP  - 2021
TI  - Efficacy and Safety of Neoadjuvant Targeted Therapy vs. Neoadjuvant Chemotherapy 
      for Stage IIIA EGFR-Mutant Non-small Cell Lung Cancer: A Systematic Review and 
      Meta-Analysis.
PG  - 715318
LID - 10.3389/fsurg.2021.715318 [doi]
LID - 715318
AB  - Purpose: The role of targeted therapy in the neoadjuvant field of stage IIIA 
      epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung 
      cancer (NSCLC) is still controversial. We sought to evaluate the efficacy and 
      safety of neoadjuvant targeted therapy (NTT) with neoadjuvant chemotherapy (NCT) 
      used as a benchmark comparator. Methods: A systematic search was conducted in 
      four databases (Pubmed, Cochrane Library, Embase, CNKI) for eligible studies on 
      NTT published before October 2020. The primary endpoints were overall survival 
      (OS), progression-free survival (PFS), objective response rate (ORR), and grade 
      3/4 adverse events (AEs). Statistical analysis and bias assessment were performed 
      by RevMan 5.3. Results: A total of 319 patients, including 3 randomized 
      controlled trials and 2 non-randomized controlled trials, were included in the 
      meta-analysis. Perform the second subgroup analysis after excluding 2 
      non-randomized controlled trials. The meta-analysis reveals that, for EGFR 
      mutation-positive stage IIIA NSCLC patients, compared with NCT, NTT can 
      significantly increase ORR (relative risk [RR]:1.70, 95% confidence interval 
      [CI]:1.35-2.15; subgroup-RR:1.56, 95% CI 1.23-2.0) and significantly reduce grade 
      3/4 AEs (RR:0.5, 95% CI 0.34-0.75; subgroup-RR: 0.53, 95% CI 0.26-1.08). The OS 
      of the NTT arm is slightly higher, but the difference is not significant (hazards 
      ratio [HR]: 0.74, 95% CI: 0.43-1.27; subgroup-HR: 0.64 95% CI 0.40-1.03). No 
      difference in PFS was found (HR: 0.81, 95% CI 0.27-2.44). Conclusion: In 
      neoadjuvant setting, targeted therapy has a definitive effect on patients with 
      EGFR mutation-positive stage IIIA NSCLC and is even better than chemotherapy in 
      terms of toxicity and tumor response rate. Systematic Review Registration: 
      PROSPERO, identifier CRD42021221136.
CI  - Copyright (c) 2021 Chen, Jin, Zhang, Xu, Zhu, Ruan, Zhang, Chen and Shen.
FAU - Chen, Dong
AU  - Chen D
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Jin, Zixian
AU  - Jin Z
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Zhang, Jian
AU  - Zhang J
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Xu, Congcong
AU  - Xu C
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Zhu, Kanghao
AU  - Zhu K
AD  - Department of Thoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, 
      China.
FAU - Ruan, Yuhang
AU  - Ruan Y
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Zhang, Bo
AU  - Zhang B
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Chen, Baofu
AU  - Chen B
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
FAU - Shen, Jianfei
AU  - Shen J
AD  - Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated 
      to Wenzhou Medical University, Linhai, China.
LA  - eng
PT  - Systematic Review
DEP - 20210819
PL  - Switzerland
TA  - Front Surg
JT  - Frontiers in surgery
JID - 101645127
PMC - PMC8417411
OTO - NOTNLM
OT  - chemotherapy
OT  - epidermal growth factor receptor
OT  - meta-analysis
OT  - molecular targeted therapy
OT  - neoadjuvant therapy
OT  - non-small cell lung cancer
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/09/08 06:00
MHDA- 2021/09/08 06:01
PMCR- 2021/08/19
CRDT- 2021/09/07 07:46
PHST- 2021/05/26 00:00 [received]
PHST- 2021/07/26 00:00 [accepted]
PHST- 2021/09/07 07:46 [entrez]
PHST- 2021/09/08 06:00 [pubmed]
PHST- 2021/09/08 06:01 [medline]
PHST- 2021/08/19 00:00 [pmc-release]
AID - 10.3389/fsurg.2021.715318 [doi]
PST - epublish
SO  - Front Surg. 2021 Aug 19;8:715318. doi: 10.3389/fsurg.2021.715318. eCollection 
      2021.