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Abstract
Purpose:
Currently, the anti-epidermal-growth-factor-receptor (EGFR) agents have shown encouraging treatment benefits in patients with various types of solid tumors including non-small-cell lung cancer (NSCLC). Despite these advances, radiological complete response to these therapies is rare. We meta-analyze the incidence of complete response (CR) in advanced NSCLC patients treated with anti-EGFR agents and controls in randomized controlled trials (RCTs).
Methods:
PubMed, Web of Science, Embase and Cochrane library databases were reviewed for phase III RCTs with EGFR-targeted agents vs. non-EGFR-targeted agents in patients with advanced NSCLC. We calculated the odds ratio of CR in patients assigned to anti-EGFR agents compared to controls.
Results:
A total of 11,568 patients from 17 RCTs were included for analysis. The incidence of CR in patients treated with anti-EGFR agents was 1.1% (95% CI, 0.7–1.7%) compared to 0.6% (95% CI, 0.4–0.9%) in control arms. Comparing the different types of anti-EGFR agents, the incidence of CR was 1.9% for gefitinib (95% CI: 1.4–2.6%), 1.4% for cetuximab (95% CI: 0.8–2.7%) and 0.9% for erlotinib (95% CI: 0.6–1.5%), respectively. The use of anti-EGFR agents significantly increased the odds ratio of obtaining a CR (OR 2.12, 95% CI: 1.28–3.49, p = 0.003) compared to controls. This was found to be higher in treatment arms involving more than 50% of: female patients, patients who had never smoked tobacco, patients of Asian descent or patients with adenocarcinoma or EGFR mutation. No significant differences in ORs were observed in any prespecified sub-groups.
Conclusion:
Although a CR is rare in advanced NSCLC patients receiving anti-EGFR agents, these drugs significantly increase the OR of a CR compared to controls, especially for patients with EGFR mutations. Further studies are needed to investigate whether the increase of CR with anti-EGFR therapy would be translated into survival benefits.
Transparency
Declaration of funding
This study was not funded.
Author contributions: Concept and design: W.-X.Q. and S.F. Search and collection of data: W.-X.Q., Q.Z. and X.-M.G. Analysis of data and interpretation: X.-M.G., W.-X. Q. Q.Z. Tables and figures: W.-X.Q., and S.F. Writing the manuscript and review: W.-X.Q. and S.F.
Declaration of financial/other relationships
W.-X.Q., S.F., Q.Z., and X.-M.G. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgement
We are indebted to the authors of the primary studies, for without their contributions, this work would have been impossible.