Abstract 1226P
Background
Anti-EGFR tyrosine kinase inhibitors (TKIs) are the standard therapy in the first-line treatment of EGFR mutant non-small cell lung cancer (NSCLC). It was aimed to increase the efficacy by adding anti-angiogenic antibodies to these agents, and several randomized controlled trials (RCTs)have been conducted in this area in recent years. Here, we performed an efficacy and safety analysis of RCTs investigating the addition of bevacizumab or ramucirumab to EGFR-TKIs in EGFR mutant advanced NSCLC.
Methods
RCTs published in Pubmed, Embase, and Cochrane Library until April 01, 2021, were scanned. Studies investigating the combination of any generation EGFR TKI with bevacizumab or ramucirumab in the first-line treatment of EGFR mutant NSCLC were included. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and grade ≥3 adverse events (AE) were compared. This meta-analysis was performed using Review Manager version 5.4 (RevMan).
Results
Six RCTs, including 1242 patients, were examined. In 4 of these studies, erlotinib and bevacizumab (n:777), one with erlotinib and ramucirumab (n:449), and one study, the combination of gefitinib and bevacizumab (n:16) was investigated. Since the number of patients in the Gefitinib study was very low, and the study was terminated early, it was excluded from the analysis due to the quality of the study. In the joint analysis of the other 5 erlotinib studies, a significant improvement in PFS was observed with the combination of bevacizumab or ramucirumab plus erlotinib (hazards ratio [HR]: 0.59, 95% CI: 0.51-0.68, p <0.01). However, there was no difference between the groups in terms of OS (HR: 0.97, 95% CI: 0.74-1.26, p = 0.81) and ORR (OR: 1.18, 95% CI: 0.91-1.54, p = 21). Grade 3 and above AE was significantly higher in the combination arm (OR: 5.01, 95% CI: 1.77-14.9, p = 0.002).
Conclusions
It was observed that adding bevacizumab or ramucirumab to erlotinib in the first-line treatment of EGFR mutant advanced NSCLC significantly prolonged PFS but did not make a difference in terms of OS and ORR. In addition, an increased incidence of grade 3 and above AE was observed in the combination arm.
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.