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Chemotherapy plus Erlotinib versus Chemotherapy Alone for Treating Advanced Non-Small Cell Lung Cancer: A Meta-Analysis.

Xu JL, Jin B, Ren ZH, Lou YQ, Zhou ZR, Yang QZ, Han BH - PLoS ONE (2015)

Bottom Line: Among patients with EGFR mutant tumors, chemotherapy plus erlotinib demonstrated significant improvements in PFS (HR = 0.31 [95% CI 0.17, 0.58], P = 0.0002) and OS (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01).Among patients with EGFR wild-type tumors, no statistically significant difference was observed with respect to PFS (HR = 0.87 [95% CI 0.70, 1.08], P = 0.21) and OS (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06).In addition, intercalated administration is an effective combinatorial strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.

ABSTRACT

Background: Whether a combination of chemotherapy and erlotinib is beneficial for advanced non-small cell lung cancer (NSCLC) remains controversial. This study aimed to summarize the currently available evidence and compare the efficacy and safety of chemotherapy plus erlotinib versus chemotherapy alone for treating advanced NSCLC.

Methods: EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Our protocol was registered in PROSPERO (CRD42014015015).

Results: Nine randomized controlled trials with a total of 3599 patients were included. Compared to chemotherapy alone, chemotherapy plus erlotinib was superior in PFS (HR = 0.76 [95% CI 0.62, 0.92], P = 0.006), and no statistically significant difference was observed in OS (HR = 0.94 [95% CI 0.86, 1.03], P = 0.16). Intercalated erlotinib plus chemotherapy demonstrated improvements in PFS (HR = 0.67 [95% CI 0.50, 0.91], P = 0.009) and OS (HR = 0.82 [95% CI 0.69, 0.98], P = 0.03). Continuous erlotinib plus chemotherapy treatment failed to demonstrate improvements in PFS (HR = 0.91 [95% CI 0.80, 1.04], P = 0.16) and OS (HR = 0.98 [95% CI 0.89, 1.09], P = 0.75). The association of chemotherapy plus erlotinib with improvement in PFS was significant in never smoking patients (HR = 0.46 [95% CI 0.37, 0.56], P<0.00001) but not in smoking patients (HR = 0.70 [95% CI 0.49, 1.00], P = 0.05). Among patients with EGFR mutant tumors, chemotherapy plus erlotinib demonstrated significant improvements in PFS (HR = 0.31 [95% CI 0.17, 0.58], P = 0.0002) and OS (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01). Among patients with EGFR wild-type tumors, no statistically significant difference was observed with respect to PFS (HR = 0.87 [95% CI 0.70, 1.08], P = 0.21) and OS (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06).

Conclusion: Combination of chemotherapy and erlotinib is a viable treatment option for patients with NSCLC, especially for patients who never smoked and patients with EGFR mutation-positive disease. In addition, intercalated administration is an effective combinatorial strategy.

No MeSH data available.


Related in: MedlinePlus

Forest Plot of Subgroup Analysis for OS.
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pone.0131278.g005: Forest Plot of Subgroup Analysis for OS.

Mentions: HRs for OS data were available from 8 trials [8, 9, 11–16]. No statistically significant improvement was shown in OS (HR = 0.94 [95% CI 0.86, 1.03], P = 0.16) (Fig 4), and there was no significant heterogeneity [χ2 = 10.36, df = 7 (P = 0.17); I2 = 32%]. Intercalated erlotinib plus chemotherapy treatment showed a modest but statistically significant improvement in OS (HR = 0.82 [95% CI 0.69, 0.98], P = 0.03) (Fig 5). Continuous erlotinib plus chemotherapy treatment failed to show an improvement in OS (HR = 0.98 [95% CI 0.89, 1.09], P = 0.75) (Fig 5). Subgroup analysis according to smoking status showed a statistically significant improvement in OS in never smoking patients (HR = 0.64 [95% CI 0.46, 0.89], P = 0.009) (Fig 5). Additionally, a statistically significant improvement in OS was observed in patients with EGFR mutant tumors (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01) (Fig 5). No significant difference in OS was noted in patients with EGFR wild-type tumors (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06) (Fig 5).


Chemotherapy plus Erlotinib versus Chemotherapy Alone for Treating Advanced Non-Small Cell Lung Cancer: A Meta-Analysis.

Xu JL, Jin B, Ren ZH, Lou YQ, Zhou ZR, Yang QZ, Han BH - PLoS ONE (2015)

Forest Plot of Subgroup Analysis for OS.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493135&req=5

pone.0131278.g005: Forest Plot of Subgroup Analysis for OS.
Mentions: HRs for OS data were available from 8 trials [8, 9, 11–16]. No statistically significant improvement was shown in OS (HR = 0.94 [95% CI 0.86, 1.03], P = 0.16) (Fig 4), and there was no significant heterogeneity [χ2 = 10.36, df = 7 (P = 0.17); I2 = 32%]. Intercalated erlotinib plus chemotherapy treatment showed a modest but statistically significant improvement in OS (HR = 0.82 [95% CI 0.69, 0.98], P = 0.03) (Fig 5). Continuous erlotinib plus chemotherapy treatment failed to show an improvement in OS (HR = 0.98 [95% CI 0.89, 1.09], P = 0.75) (Fig 5). Subgroup analysis according to smoking status showed a statistically significant improvement in OS in never smoking patients (HR = 0.64 [95% CI 0.46, 0.89], P = 0.009) (Fig 5). Additionally, a statistically significant improvement in OS was observed in patients with EGFR mutant tumors (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01) (Fig 5). No significant difference in OS was noted in patients with EGFR wild-type tumors (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06) (Fig 5).

Bottom Line: Among patients with EGFR mutant tumors, chemotherapy plus erlotinib demonstrated significant improvements in PFS (HR = 0.31 [95% CI 0.17, 0.58], P = 0.0002) and OS (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01).Among patients with EGFR wild-type tumors, no statistically significant difference was observed with respect to PFS (HR = 0.87 [95% CI 0.70, 1.08], P = 0.21) and OS (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06).In addition, intercalated administration is an effective combinatorial strategy.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.

ABSTRACT

Background: Whether a combination of chemotherapy and erlotinib is beneficial for advanced non-small cell lung cancer (NSCLC) remains controversial. This study aimed to summarize the currently available evidence and compare the efficacy and safety of chemotherapy plus erlotinib versus chemotherapy alone for treating advanced NSCLC.

Methods: EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Our protocol was registered in PROSPERO (CRD42014015015).

Results: Nine randomized controlled trials with a total of 3599 patients were included. Compared to chemotherapy alone, chemotherapy plus erlotinib was superior in PFS (HR = 0.76 [95% CI 0.62, 0.92], P = 0.006), and no statistically significant difference was observed in OS (HR = 0.94 [95% CI 0.86, 1.03], P = 0.16). Intercalated erlotinib plus chemotherapy demonstrated improvements in PFS (HR = 0.67 [95% CI 0.50, 0.91], P = 0.009) and OS (HR = 0.82 [95% CI 0.69, 0.98], P = 0.03). Continuous erlotinib plus chemotherapy treatment failed to demonstrate improvements in PFS (HR = 0.91 [95% CI 0.80, 1.04], P = 0.16) and OS (HR = 0.98 [95% CI 0.89, 1.09], P = 0.75). The association of chemotherapy plus erlotinib with improvement in PFS was significant in never smoking patients (HR = 0.46 [95% CI 0.37, 0.56], P<0.00001) but not in smoking patients (HR = 0.70 [95% CI 0.49, 1.00], P = 0.05). Among patients with EGFR mutant tumors, chemotherapy plus erlotinib demonstrated significant improvements in PFS (HR = 0.31 [95% CI 0.17, 0.58], P = 0.0002) and OS (HR = 0.52 [95% CI 0.30, 0.88], P = 0.01). Among patients with EGFR wild-type tumors, no statistically significant difference was observed with respect to PFS (HR = 0.87 [95% CI 0.70, 1.08], P = 0.21) and OS (HR = 0.78 [95% CI 0.59, 1.01], P = 0.06).

Conclusion: Combination of chemotherapy and erlotinib is a viable treatment option for patients with NSCLC, especially for patients who never smoked and patients with EGFR mutation-positive disease. In addition, intercalated administration is an effective combinatorial strategy.

No MeSH data available.


Related in: MedlinePlus