Background: In the first line treatment of non-small cell lung cancer (NSCLC), several clinical trials haveshown that not all NSCLC patients can benefit from treatment with tyrosine kinase inhibitors(TKIs) than receiving chemotherapy. Some trials treated patients with TKI according to theirclinical characteristics. A few studies only chose patients with an epidermal grouth factorreceptor (EGFR) mutation for TKI therapy. We aimed to determine whether patients could betreated with TKIs based on clinical factors in the first-line setting. Methods: We performed a meta-analysis of randomized trials involving patients with advanced NSCLCtreated with chemotherapy or TKIs by different selections. Efficacy outcomes of interestwere the objective response rate (ORR), progression-free survival (PFS) and the overallsurvival (OS) of each treatment arm. Results: Four trials enrolled unselected patients, and two trials selected East Asian patients using theclinical factors of gender and smoking history. Five trials chose patients with an EGFRmutation who were randomized for treatment with TKI or chemotherapy. For unselectedpatients, the risk ratio (RR) of the ORR was 3.52, the hazard ratio (HR) of the PFS was 1.29and the HR of the OS was 1.35. For the clinically selected patients, the RR of the ORR was0.64. The HRs of the PFS and OS were 0.83 and 0.92, respectively. The ORR and PFS werebetter for TKIs than for chemotherapy in patients with an EGFR mutation. The ORR was0.47, and the HRs of the PFS and OS were 0.36 and 1.00, respectively. Conclusions: Advanced NSCLC patients with an EGFR mutation benefit most from TKIs. EGFR-TKItreatment is justified for patients with unknown EGFR status,and those who cannot toleratechemotherapy owing to age, poor performance status (PS) or other medical conditions, whenselected according to clinical factors in the first-line setting.
via Journal of Hematology & Oncology
via Journal of Hematology & Oncology
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