Abstract 664P
Background
Currently, chemotherapy combination regimens are the backbone for NSCLC patients who show disease progression after EGFR-TKI failure. There are three main chemotherapeutic combination strategies: chemotherapy plus anti-VEGF, chemotherapy plus anti-PD-1, and chemotherapy plus anti-VEGF plus anti-PD-1. To date, no meta-analysis has comprehensively assessed the optimal combination strategy, which is important for improving clinical benefit when combined with chemotherapy, anti-VEGF, or anti-PD-1. T.
Methods
PubMed, Embase, and Cochrane Library were systematically searched until May 31, 2024, as well as major oncology conferences. Phase II and phase III RCTs reporting the use of chemotherapy plus anti-VEGF, chemotherapy plus anti-PD-1, and chemotherapy plus anti-VEGF with anti-PD-1 in patients with EGFR-TKI-resistant NSCLC were included. The primary outcome was PFS, and the secondary outcome was OS.HRs with 95%CIs for PFS and OS were extracted and pooled through a Bayesian network meta-analysis.
Results
Eight eligible phase III RCTs involving 2148 EGFR-TKI resistant NSCLC were included. In terms of PFS, all three chemotherapy combination regimens yielded better benefits than chemotherapy alone (P<0.05). Chemotherapy plus anti-VEGF with anti-PD-1 showed the most favorable PFS, with a significant difference versus chemotherapy plus anti-VEGF (HR=0.67, 95%CI 0.53-0.85), but without significant difference versus chemotherapy plus anti-VEGF (HR=0.75, 95%CI 0.54-1.01). In terms of OS, no significant difference was observed in any comparable regimen, and none of the combination treatments produced significantly better OS benefits than chemotherapy alone (P>0.05).
Conclusions
This network meta-analysis demonstrated that chemotherapy plus anti-VEGF and anti-PD-1 antibodies may be the optimal strategy for patients with EGFR-TKI-resistant NSCLC. The addition of anti-VEGF agents is important for improving the PFS in these patients when combined with chemotherapy alone or chemotherapy plus anti-PD-1. Further validation of these findings is warranted through head-to-head RCTs.
Clinical trial identification
CRD42024556543.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.