PMID- 38300281
OWN - NLM
STAT- MEDLINE
DCOM- 20240314
LR  - 20240314
IS  - 1432-1041 (Electronic)
IS  - 0031-6970 (Linking)
VI  - 80
IP  - 4
DP  - 2024 Apr
TI  - Feasibility and safety of EGFR-TKI neoadjuvant therapy for EGFR-mutated NSCLC: A 
      meta-analysis.
PG  - 505-517
LID - 10.1007/s00228-024-03620-w [doi]
AB  - BACKGROUND: The role of neoadjuvant epidermal growth factor receptor 
      (EGFR)-tyrosine kinase inhibitor (TKI) targeted therapy for EGFR-mutated 
      non-small cell lung cancer (NSCLC) is unclear. Previous studies have shown that 
      EGFR-TKIs have excellent anti-tumor activity. However, almost all studies on 
      neoadjuvant EGFR-TKI treatment for EGFR-mutated NSCLC have been non-randomized 
      controlled trials with small sample sizes and different methods of statistical 
      analysis, which may lead to a lack of valid metrics to assess the feasibility and 
      safety of neoadjuvant EGFR-TKI treatment. This meta-analysis aimed to assess the 
      efficacy and safety of neoadjuvant EGFR-TKI treatment for NSCLC patients with 
      EGFR mutations. METHODS: Relevant studies were systematically searched in PubMed, 
      Embase, and Web of Science databases. Results including objective response rate 
      (ORR), complete resection rate (R0), downstaging rate, pathological complete 
      response (PCR), major pathological response (MPR), progression-free survival 
      (PFS), overall survival (OS), and adverse events (AEs) were used for further 
      analysis. RESULTS: This meta-analysis ultimately included 11 studies involving 
      344 patients with EGFR-positive mutations in NSCLC. In terms of tumor response, 
      the pooled ORR was 57% (95% CI: 42%-73%), and in the Osimertinib subgroup, the 
      pooled ORR was 80% (95% CI: 63%-98%). Analysis of studies that reported a 
      downstaging rate showed the pooled downstaging rate of 41% (95% CI: 9%-74%) and 
      the pooled downstaging rate of 74% (95% CI: 22%-100%) in the Osimertinib 
      subgroup. In terms of surgical outcomes, the pooled pCR rate was 3% (95% CI: 
      0%-7%), the pooled MPR rate was 11% (95% CI: 6%-17%), and the pooled R0 resection 
      rate was 91% (95% CI: 85%-95%). The most common adverse events associated with 
      neoadjuvant therapy were rash and diarrhea. The pooled incidence of any grade of 
      rash was 47.1% (95% CI: 25.4%-69.3%), and the pooled incidence of grade >/= 3 rash 
      was 0.6% (95% CI: 0.0%-2.5%). The pooled incidence of diarrhea of any grade was 
      28.8% (95% CI: 14.4%-45.4%), with the pooled incidence of grade >/= 3 diarrhea of 
      0.2% (95% CI: 0.0%-1.6%). The pooled incidence of >/= grade 3 adverse events was 
      significantly lower. CONCLUSIONS: Our meta-analysis confirmed the efficacy and 
      safety of neoadjuvant EGFR-TKIs for the treatment of NSCLC patients with 
      EGFR-positive mutations and that third-generation EGFR-TKIs were superior to 
      first- and second-generation EGFR-TKIs in terms of shrinking tumor volume and 
      lowering tumor stage; however, future large-scale and multicenter randomized 
      controlled trials are needed to confirm this conclusion. SYSTEMATIC REVIEW 
      REGISTRATION: PROSPERO CRD42023466731.
CI  - (c) 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Yu, Zhuchen
AU  - Yu Z
AD  - Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital 
      of Nanchang University, Nanchang, Jiangxi, China.
FAU - Xu, Fei
AU  - Xu F
AD  - Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital 
      of Nanchang University, Nanchang, Jiangxi, China. xfjxmc@163.com.
FAU - Zou, Juntao
AU  - Zou J
AD  - Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital 
      of Nanchang University, Nanchang, Jiangxi, China. ndyfy09628@ncu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20240201
PL  - Germany
TA  - Eur J Clin Pharmacol
JT  - European journal of clinical pharmacology
JID - 1256165
RN  - 3C06JJ0Z2O (osimertinib)
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Protein Kinase Inhibitors)
RN  - EC 2.7.10.1 (ErbB Receptors)
RN  - EC 2.7.10.1 (EGFR protein, human)
RN  - 0 (Acrylamides)
RN  - 0 (Aniline Compounds)
RN  - 0 (Indoles)
RN  - 0 (Pyrimidines)
SB  - IM
MH  - Humans
MH  - *Carcinoma, Non-Small-Cell Lung/drug therapy
MH  - *Lung Neoplasms/drug therapy
MH  - Neoadjuvant Therapy
MH  - Feasibility Studies
MH  - *Antineoplastic Agents
MH  - Protein Kinase Inhibitors/adverse effects
MH  - ErbB Receptors/genetics
MH  - Diarrhea/chemically induced
MH  - *Exanthema/chemically induced
MH  - Mutation
MH  - Multicenter Studies as Topic
MH  - *Acrylamides
MH  - *Aniline Compounds
MH  - *Indoles
MH  - *Pyrimidines
OTO - NOTNLM
OT  - Epidermal growth factor receptor-tyrosine kinase inhibitor
OT  - Feasibility
OT  - Neoadjuvant therapy
OT  - Non-small cell lung cancer
OT  - Safety
EDAT- 2024/02/01 12:44
MHDA- 2024/03/14 06:46
CRDT- 2024/02/01 11:06
PHST- 2023/10/14 00:00 [received]
PHST- 2024/01/04 00:00 [accepted]
PHST- 2024/03/14 06:46 [medline]
PHST- 2024/02/01 12:44 [pubmed]
PHST- 2024/02/01 11:06 [entrez]
AID - 10.1007/s00228-024-03620-w [pii]
AID - 10.1007/s00228-024-03620-w [doi]
PST - ppublish
SO  - Eur J Clin Pharmacol. 2024 Apr;80(4):505-517. doi: 10.1007/s00228-024-03620-w. 
      Epub 2024 Feb 1.