Cumulative meta-analysis of epidermal growth factor receptor-tyrosine kinase inhibitors as first-line therapy in metastatic non-small-cell lung cancer.

We carried out a meta-analysis to evaluate the benefit of epidermal growth factor-tyrosine kinase inhibitors (EGFR-TKI) over the standard first-line platinum-based chemotherapy for metastatic non-small-cell lung cancer (NSCLC). Studies that were considered eligible included controlled prospective randomized phase III studies in patients with NSCLC stages IIIB or IV. These patients received standard first-line platinum-based chemotherapy or EGFR-TKI; overall survival and progression-free survival (PFS) with adequate data were available to calculate and estimate the hazard ratio (HR) with a confidence interval (CI) of 95%. Eight studies were identified that compared EGFR-TKI versus standard first-line platinum-based chemotherapy to treat NSCLC in 2962 patients. Patients receiving EGFR-TKI showed significantly longer PFS [HR=0.266 (95% CI=0.20-0.35), P<0.0001]. No significant difference in overall survival [HR=0.946 (95% CI=0.35-2.53), P=0.912] was observed between the groups. The cumulative meta-analysis of the studies showed that, since 2011 (OPTIMAL study), the PFS benefit in the EGFR-TKI arm was statistically significantly longer. Toxicity values greater than or equal to 3 in the most prevalent EGFR-TKI group included skin rash, diarrhea, and increased aminotransferase. EGFR-TKI treatment significantly extends PFS, with acceptable toxicities than platinum-based chemotherapy. Thus, they should be considered as the first choice in the first-line treatment for patients with NSCLC and with the EGFR mutation.