Abstract 1077P
Background
TKIs are standard care option in patients of NSCLC with EGFR mutation. TKIs-based combination treatment modes have shown encouraging outcomes. However, it remains unknown which is the optimal treatment as the first-line regimen for these patients on OS.
Methods
RCTs and meeting abstracts that investigated EGFR-TKIs alone or in combination as front-line care for patients with NSCLC were systematically searched in relevant databases and reviewed. Fixed effects and random effects network meta-analysis models were used to estimate PFS, OS, ORR, and AEs. SUCRAs were used to rank treatment effects.
Results
Eighteen studies covering six treatments and involving a total of 4389 patients were included in this network meta-analysis. On OS, the 2G EGFR-TKIs (HR 0.81, 95%CI 0.67 to 0.98), 1G EGFR-TKIs plus chemotherapy (HR 0.73, 95%CI 0.63 to 0.85) and osimertinib (HR 0.80, 95%CI 0.64 to 1.00) were all more effective in comparison with 1G EGFR-TKIs in improving OS. The top 3 treatment were first-generation EGFR-TKIs (1G EGFR-TKIs) plus chemotherapy (SUCRA, 88.1%), osimertinib (SUCRA, 65.8%) and second-generation EGFR-TKIs (2GEGFR-TKIs) (SUCRA, 63.3%). For patients with ex19del, osimertinib (HR 0.80, 95%CI 0.64 to 1.00), 2G EGFR-TKIs (HR 0.81, 95%CI 0.67 to 0.98), and 1G EGFR-TKIs plus chemotherapy (HR 0.73, 95%CI 0.63 to 0.85) were all more effective in improving OS. 1G EGFR-TKIs plus chemotherapy (86.7%), osimertinib (80.7%) were the top treatments in OS. And for patients with L858R mutation, only 1G EGFR-TKIs plus chemotherapy tend to improve OS (HR 0.71, 95%CI 0.50 to 1.00). 1G EGFR-TKIs plus chemotherapy (84.6%), was the top best treatments in OS. Itwo combination treatments, the 1G EGFR-TKIs plus chemotherapy (HR 0.57, 95%CI 0.36 to 0.9, SUCRA 85.6%) improved OS in patients with CNS metastasis, compared with 1G EGFR-TKIs alone.
Conclusions
1G EGFR-TKIs plus chemotherapy and osimertinib were the top 2 best options as first-line management in advanced NSCLC patients with EGFR-mutation. Combination of 1G EGFR-TKIs and chemotherapy surpassed osimertinib and was ranked the top in terms of OS, both in all population and in patients with CNS metastasis.
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.