PMID- 35346117
OWN - NLM
STAT- MEDLINE
DCOM- 20220404
LR  - 20220405
IS  - 1471-2407 (Electronic)
IS  - 1471-2407 (Linking)
VI  - 22
IP  - 1
DP  - 2022 Mar 26
TI  - Efficacy and safety of adjuvant EGFR-TKIs for resected non-small cell lung 
      cancer: a systematic review and meta-analysis based on randomized control trials.
PG  - 328
LID - 10.1186/s12885-022-09444-0 [doi]
LID - 328
AB  - BACKGROUND: Postoperative adjuvant cisplatin-based chemotherapy had been the 
      standard care in patients with completely resected high-risk stage IB to IIIA 
      non-small cell lung cancer (NSCLC) for decades. However, the survival benefits 
      were far from satisfactory in clinical practice. Thus, this meta-analysis was 
      performed to compare the efficacy and safety of adjuvant epidermal growth factor 
      receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with resected NSCLC 
      based on updated literature and research. METHODS: A systematic literature search 
      based on random control trials (RCTs) was conducted with keywords on PubMed, 
      Embase and the Cochrane library databases. All articles compared EGFR-TKIs to 
      placebo or chemotherapy as adjuvant therapies for early-stage resected NSCLC. A 
      meta-analysis was performed to generate combined hazard ratio (HR) with 95% 
      confidence intervals (CI) for disease-free survival (DFS), overall survival (OS), 
      and risk ratio (RR) with 95% CI for disease recurrence and adverse events (AEs). 
      The Stata statistical software (version 14.0) was used to synthesis the data. 
      RESULTS: A total of 9 RCTs comprising 3098 patients were included. Adjuvant 
      EGFR-TKIs could significantly prolong DFS in patient with resected NSCLC 
      harboring epidermal growth factor receptor (EGFR) mutations (HR 0.46, 95% CI 
      0.29-0.72), but had no impact on OS (HR 0.87, 95% CI 0.69-1.11). The subgroup 
      analyses indicated that adjuvant EGFR-TKIs were superior in regard to DFS in most 
      subgroups, including varied smoking status, EGFR mutations type, gender, age, 
      Eastern Cooperative Oncology Group performance status and adenocarcinoma. 
      Osimertinib resulted in decreased brain recurrence than first generation of 
      EGFR-TKIs (RR 0.12, 95% CI 0.04-0.34 vs. RR 1.07, 95% CI 0.64-1.78, 
      respectively). The AEs were generally manageable and tolerable. The incidence of 
      high-grade (>/= 3) AEs including diarrhea (RR 5.68, 95% CI 2.94-10.98) and rash (RR 
      27.74, 95% CI 11.43-67.30) increased after adjuvant EGFR-TKIs treatment. 
      CONCLUSIONS: Adjuvant EGFR-TKIs therapy could significantly prolong DFS in 
      patients with completely resected early-stage EGFR mutation-positive NSCLC, but 
      had no impact on OS. Adjuvant EGFR-TKIs could be an important treatment option in 
      patients with resected early-stage EGFR-mutant NSCLC.
CI  - (c) 2022. The Author(s).
FAU - Zhao, Pengfei
AU  - Zhao P
AD  - Department of Radiotherapy, Beijing Friendship Hospital, Capital Medical 
      University, No.95 Yong An Road, Xicheng District, Beijing, 100050, China.
FAU - Zhen, Hongchao
AU  - Zhen H
AD  - Department of Oncology, Beijing Friendship Hospital, Capital Medical University, 
      No.95 Yong An Road, Xicheng District, Beijing, 100050, China.
FAU - Zhao, Hong
AU  - Zhao H
AD  - Department of Radiotherapy, Beijing Friendship Hospital, Capital Medical 
      University, No.95 Yong An Road, Xicheng District, Beijing, 100050, China.
FAU - Zhao, Lei
AU  - Zhao L
AD  - Department of Oncology, Beijing Friendship Hospital, Capital Medical University, 
      No.95 Yong An Road, Xicheng District, Beijing, 100050, China.
FAU - Cao, Bangwei
AU  - Cao B
AD  - Department of Oncology, Beijing Friendship Hospital, Capital Medical University, 
      No.95 Yong An Road, Xicheng District, Beijing, 100050, China. 
      oncology@ccmu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20220326
PL  - England
TA  - BMC Cancer
JT  - BMC cancer
JID - 100967800
RN  - 0 (Protein Kinase Inhibitors)
RN  - EC 2.7.10.1 (EGFR protein, human)
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy/genetics/surgery
MH  - Chemotherapy, Adjuvant
MH  - ErbB Receptors
MH  - Humans
MH  - *Lung Neoplasms/drug therapy/genetics/surgery
MH  - Protein Kinase Inhibitors/adverse effects
PMC - PMC8962534
OTO - NOTNLM
OT  - Adjuvant EGFR-TKI
OT  - Adjuvant chemotherapy
OT  - Adjuvant therapy
OT  - NSCLC
OT  - Resected tumor
COIS- All the authors declared that they had no competing interest.
EDAT- 2022/03/30 06:00
MHDA- 2022/04/05 06:00
PMCR- 2022/03/26
CRDT- 2022/03/29 05:38
PHST- 2021/12/24 00:00 [received]
PHST- 2022/03/23 00:00 [accepted]
PHST- 2022/03/29 05:38 [entrez]
PHST- 2022/03/30 06:00 [pubmed]
PHST- 2022/04/05 06:00 [medline]
PHST- 2022/03/26 00:00 [pmc-release]
AID - 10.1186/s12885-022-09444-0 [pii]
AID - 9444 [pii]
AID - 10.1186/s12885-022-09444-0 [doi]
PST - epublish
SO  - BMC Cancer. 2022 Mar 26;22(1):328. doi: 10.1186/s12885-022-09444-0.