PMID- 35985780
OWN - NLM
STAT- MEDLINE
DCOM- 20220823
LR  - 20220907
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 12
IP  - 8
DP  - 2022 Aug 19
TI  - Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive 
      advanced non-small-cell lung cancer: a systematic review and meta-analysis of 
      randomised controlled trials.
PG  - e062036
LID - 10.1136/bmjopen-2022-062036 [doi]
LID - e062036
AB  - OBJECTIVES: Combination treatment with erlotinib plus bevacizumab has the 
      potential to become a standard treatment regimen for patients with epidermal 
      growth factor receptor mutation-positive (EGFRm(+)) advanced non-small cell lung 
      cancer (NSCLC). This study aimed to investigate the efficacy and safety of 
      erlotinib plus bevacizumab in patients with EGFRm(+) advanced NSCLC. DESIGN: 
      Systematic review and meta-analysis. DATA SOURCES: The PubMed, Embase, Web of 
      Science and Cochrane Library databases were searched, from inception to 15 
      January 2022. ELIGIBILITY CRITERIA: We included randomised controlled trials 
      (RCTs), reported in English, assessing the efficacy of erlotinib plus bevacizumab 
      versus erlotinib monotherapy in patients with EGFRm (+) advanced NSCLC. DATA 
      EXTRACTION AND SYNTHESIS: The main objective was to assess overall survival (OS), 
      progression-free survival (PFS), objective response rate (ORR) and adverse events 
      (AEs). Two independent reviewers extracted data and assessed the risk of bias. A 
      random-effects model was used where there was evidence for homogeneous effects. 
      RESULTS: Four RCTs (reported across six publications) were included in the 
      meta-analysis, with a total of 775 patients included in the pooled analyses of 
      PFS, OS and ORR (387 in the erlotinib plus bevacizumab intervention group and 388 
      in the erlotinib group). Compared with the erlotinib alone group, the erlotinib 
      plus bevacizumab group achieved a significantly prolonged PFS (HR: 0.59; 95% CI 
      0.49 to 0.72; p<0.00001; I(2)=0%), but OS (HR: 0.95; 95% CI 0.78 to 1.15; p=0.59; 
      I(2)=0%) and ORR (OR: 1.25; 95% CI 0.89 to 1.74; p=0.19; I(2)=0%) were not 
      significantly prolonged. A total of 776 cases were used for a pooled analysis of 
      AEs. Regarding AEs, combined treatment significantly increased the incidence of 
      diarrhoea (51% vs 43%, 95% CI 1.03 to 1.38; p=0.006), haemorrhagic events (41% vs 
      20%, 95% CI 1.12 to 6.31; p=0.03), proteinuria (25% vs 3%, 95% CI 4.86 to 17.66; 
      p<0.0001) and hypertension (40% vs 8%, 95% CI 3.66 to 7.88; p<0.0001). 
      CONCLUSIONS: Erlotinib plus bevacizumab for the treatment of patients with 
      EGFRm(+) advanced NSCLC was associated with significantly prolonged PFS compared 
      with erlotinib alone, but the combination did not prolong OS.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Deng, Wusheng
AU  - Deng W
AUID- ORCID: 0000-0002-2539-8559
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Wang, Ke
AU  - Wang K
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Jiang, Yun
AU  - Jiang Y
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Shaoyang University, Shaoyang, China.
FAU - Li, Dingbin
AU  - Li D
AD  - Department of Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital 
      of Guangxi Medical University, Nanning, China.
FAU - Bao, Chongxi
AU  - Bao C
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Luo, Jing
AU  - Luo J
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Liu, Liuyuan
AU  - Liu L
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Huang, Bing
AU  - Huang B
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China.
FAU - Kong, Jinliang
AU  - Kong J
AD  - Department of Respiratory and Critical Care Medicine, The First Affiliated 
      Hospital of Guangxi Medical University, Nanning, China kjl071@163.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20220819
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
RN  - 0 (Protein Kinase Inhibitors)
RN  - 2S9ZZM9Q9V (Bevacizumab)
RN  - DA87705X9K (Erlotinib Hydrochloride)
RN  - EC 2.7.10.1 (EGFR protein, human)
RN  - EC 2.7.10.1 (ErbB Receptors)
SB  - IM
MH  - *Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Bevacizumab/adverse effects
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - *ErbB Receptors/genetics
MH  - Erlotinib Hydrochloride/adverse effects/therapeutic use
MH  - Humans
MH  - Lung Neoplasms/drug therapy
MH  - Protein Kinase Inhibitors
MH  - Randomized Controlled Trials as Topic
PMC - PMC9396158
OTO - NOTNLM
OT  - adult oncology
OT  - gene therapy
OT  - respiratory tract tumours
COIS- Competing interests: None declared.
EDAT- 2022/08/20 06:00
MHDA- 2022/08/24 06:00
PMCR- 2022/08/19
CRDT- 2022/08/19 21:12
PHST- 2022/08/19 21:12 [entrez]
PHST- 2022/08/20 06:00 [pubmed]
PHST- 2022/08/24 06:00 [medline]
PHST- 2022/08/19 00:00 [pmc-release]
AID - bmjopen-2022-062036 [pii]
AID - 10.1136/bmjopen-2022-062036 [doi]
PST - epublish
SO  - BMJ Open. 2022 Aug 19;12(8):e062036. doi: 10.1136/bmjopen-2022-062036.