A Bayesian network meta-analysis of EGFR-tyrosine kinase inhibitor treatments in patients with EGFR mutation-positive non-small cell lung cancer☆  

作　　者：Jianqiong Yin Jing Huang Min Ren Rui Tang Linshen Xie Jianxin Xue 

机构地区：[1]Department of Thoracic Oncology,Cancer Center and State Key Laboratory of Biotherapy,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China [2]Department of Ultrasound,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China [3]Abdominal Oncology Ward,Division of Radiation Oncology,Cancer Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China [4]West China School of Public Health and West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,China [5]Division of Thoracic Tumor Multimodality Treatment Cancer Center,The National Clinical Research Center for Geriatrics,West China Hospita,Sichuan University,Chengdu,Sichuan 610041,China [6]Laboratory of Clinical Cell Therapy,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China

出　　处：《Cancer Pathogenesis and Therapy》2025年第2期135-146,共12页癌症发生与治疗(英文)

基　　金：supported by the National Natural Science Foundation of China(No.82373021);1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYYC23010);the Natural Science Foundation of Science and Technology Department of Sichuan Province(No.2023ZYD0094);the National Clinical Research Center for Geriatrics(No.Z2021JC001).

摘　　要：Background:To date,no direct comparisons have been performed to compare the effectiveness of all epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)against EGFR mutation-positive non-small cell lung cancer(NSCLC).This study aimed to investigate the efficacy and safety of EGFR-TKIs in patients with EGFR mutation-positive NSCLC.Methods:We conducted a network meta-analysis of randomized controlled trials comparing osimertinib,lazertinib,aumolertinib,befotertinib,furmonertinib,dacomitinib,afatinib,erlotinib,gefitinib,icotinib,and chemotherapy.Pooled estimations of progression-free survival(PFS),overall survival(OS),objective response rate(ORR),and toxicity(grade≥3 adverse events)were performed within the Bayesian framework.Results:Twenty-three trials involving 11 treatments were included.All EGFR-TKIs improved PFS relative to chemotherapy,except for icotinib(hazard ratio[HR]=0.61,95%confidence interval[CI]:0.26-1.44).All EGFR-TKIs demonstrated significant ORR benefits over chemotherapy.Osimertinib seemed to prolong PFS compared with icotinib(HR=0.29,95%CI:0.1-0.86),gefitinib(HR=0.39,95%CI:0.21-0.74),and erlotinib(HR=0.53,95%CI:0.29-1.0).In addition,osimertinib showed favorable superiority in improving OS compared with chemotherapy(HR=0.6,95%CI:0.43-0.82),gefitinib(HR=0.61,95%CI:0.45-0.83),erlotinib(HR=0.65,95%CI:0.48-0.89),and afatinib(HR=0.65,95%CI:0.44-0.94).Among these regimens,afatinib showed the highest ORR(cumulative probability:96.96%).Icotinib was associated with minimal toxicity among the EGFR-TKIs,followed by furmonertinib and osimertinib.Moreover,the toxicity spectra differed among the EGFR-TKIs.Subgroup analyses of patients with two common types of EGFR mutations indicated that furmonertinib possessed the greatest PFS benefit in patients with exon 19 deletion,and lazertinib showed the greatest PFS benefit in patients with Leu858Arg mutation.We also identified differences between EGFR-TKIs in prolonging PFS in patients with brain metastasis.Conclusions:Osimertinib is the first choice o

关 键 词：Non-small cell lung cancer EGFR-TKI Network meta-analysis SURVIVAL TOXICITY 

分 类 号：R734.2[医药卫生—肿瘤]