Binghao Zhao1, Wenxiong Zhang2, Dongliang Yu1, Jianjun Xu1, Yiping Wei1. 1. Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China. 2. Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China. Electronic address: zwx123dr@126.com.
Abstract
OBJECTIVES: A role for erlotinib and bevacizumab as single agents has been established in the treatment of non-small cell lung cancer (NSCLC). However, the efficacy and safety of erlotinib in combination with bevacizumab compared with single agents remain unclear. This meta-analysis aimed to investigate the status of this combined strategy in NSCLC. MATERIALS AND METHODS: We systematically searched relevant databases for randomized controlled trials (RCTs) on the use of erlotinib plus bevacizumab in NSCLC. The main outcomes analysis reported overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse effects. Random-effects models were used to estimate pooled hazard ratio and relative risk. RESULTS: Ten studies with a total of 2802 participants were eligible for meta-analysis, the results of which suggested erlotinib with bevacizumab failed to significantly enhance either OS (95% CI: 0.87-1.12; P = 0.825) or ORR (95% CI: 0.69-1.67; P = 0.758). Though PFS was modestly improved, there was no statistical significance (5.55 months vs. 4.67 months, 95% CI: 0.63-1.15; P = 0.297). Incidence of rash or diarrhea was higher in the combination group than in the single-agent group. Subgroup analysis showed encouraging OS (95% CI: 0.29-0.69; P < 0.001) in epidermal growth factor receptor (EGFR)-mutant patients treated with combination therapy, no such benefits were found in groups restricting on KRAS status. CONCLUSION: Erlotinib plus bevacizumab enhances OS for EGFR-mutant patients, with rash and diarrhea common but acceptable adverse effects. Combination treatment can be recommended as the preferable option for EGFR-mutant patients. Further large-scale, well-designed RCTs are required to confirm our validation.
OBJECTIVES: A role for erlotinib and bevacizumab as single agents has been established in the treatment of non-small cell lung cancer (NSCLC). However, the efficacy and safety of erlotinib in combination with bevacizumab compared with single agents remain unclear. This meta-analysis aimed to investigate the status of this combined strategy in NSCLC. MATERIALS AND METHODS: We systematically searched relevant databases for randomized controlled trials (RCTs) on the use of erlotinib plus bevacizumab in NSCLC. The main outcomes analysis reported overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse effects. Random-effects models were used to estimate pooled hazard ratio and relative risk. RESULTS: Ten studies with a total of 2802 participants were eligible for meta-analysis, the results of which suggested erlotinib with bevacizumab failed to significantly enhance either OS (95% CI: 0.87-1.12; P = 0.825) or ORR (95% CI: 0.69-1.67; P = 0.758). Though PFS was modestly improved, there was no statistical significance (5.55 months vs. 4.67 months, 95% CI: 0.63-1.15; P = 0.297). Incidence of rash or diarrhea was higher in the combination group than in the single-agent group. Subgroup analysis showed encouraging OS (95% CI: 0.29-0.69; P < 0.001) in epidermal growth factor receptor (EGFR)-mutant patients treated with combination therapy, no such benefits were found in groups restricting on KRAS status. CONCLUSION:Erlotinib plus bevacizumab enhances OS for EGFR-mutant patients, with rash and diarrhea common but acceptable adverse effects. Combination treatment can be recommended as the preferable option for EGFR-mutant patients. Further large-scale, well-designed RCTs are required to confirm our validation.
Authors: Niki Karachaliou; Manuel Fernandez-Bruno; Jillian Wilhelmina Paulina Bracht; Rafael Rosell Journal: Transl Cancer Res Date: 2019-01 Impact factor: 1.241