Abstract 700P
Background
EGFR mutations are found in up to 50% of Asian patients with non-small cell lung carcinoma, and gefitinib is one of the recommended first-line therapy for those with advanced disease. However, patients develop resistance to gefitinib as a result of a T790M mutation in EGFR exon 20. In an effort to overcome this, clinicians have looked into combining gefitinib with chemotherapy. This meta-analysis aims to compare the efficacy and survival benefits of gefitinib plus chemotherapy versus gefitinib monotherapy among EGFR mutant stage IV non-small cell lung cancer patients.
Methods
A systematic search of articles on PubMed, Cochrane, Google Scholar, and hand-searching was utilized to identify randomized trials investigating gefitinib plus chemotherapy versus gefitinib monotherapy in the treatment of EGFR mutan tstage IV non-small cell lung cancer. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Inverse variance was used with random effects as the analysis model in the production of the forest plot and calculation of the risk ratio at 95% confidence intervals.
Results
Analysis of overall survival included all 4 studies and showed that the gefitinib plus chemotherapy group has 2.12 times higher statistically significant overall survival compared to the gefitinib group (OR 2.12, 95% CI 1.56-2.86, p < 0.00001), with a computed I2 of 10% (p = 0.34) suggesting mild or non-significant heterogeneity. Analysis of 3 studies with PFS data showed a 3.22 times higher PFS in the gefitinib plus chemotherapy group compared to gefitinib monotherapy (OR 3.22, 95% CI 2.15–4.81, p < 0.00001) with moderate heterogeneity (I2 of 10%, p = 0.16). Analysis of 3 studies with ORR data showed 2.15 times higher ORR in the gefitinib plus chemotherapy group compared to gefitinib monotherapy (OR 2.15, 95% CI 1.58-2.92, p < 0.00001) with absent heterogeneity (I2 of 0%, p = 0.62).
Conclusions
Gefitinib plus chemotherapy has been shown to be beneficial as a first-line treatment option for EGFR-mutated NSCLC. It has statistically significant improvements in ORR, OS, and PFS as compared to gefitinib alone and has manageable adverse events.
Clinical trial identification
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.