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Lung Cancer |

Sequential Treatment of Tyrosine Kinase Inhibitors and Chemotherapy for EGFR-Mutated Non-small Cell Lung Cancer: A Meta-analysis of Phase III Trials

Yiliang Zhang, MS; Yihua Sun, MD; Lei Wang; Ting Ye, MS; Yunjian Pan, MS; Haichuan Hu, MD; Yongfu Yu, MS; David Garfield, PhD; Haiquan Chen, PhD
Author and Funding Information

Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China


Chest. 2014;145(3_MeetingAbstracts):348A. doi:10.1378/chest.1835860
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Abstract

SESSION TITLE: Lung Cancer I

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 02:15 PM - 03:45 PM

PURPOSE: This study was aimed to compare the efficacy of first-line tyrosine kinase inhibitor (TKI) followed, upon progression, by chemotherapy with the reverse sequence in patients with EGFR-mutated NSCLC in terms of overall survival (OS).

METHODS: We performed a meta-analysis of studies which met the following criteria: phase III clinical trials comparing the sequencing of EGFR TKIs with chemotherapy in treatment of advanced EGFR-mutated NSCLC; activating mutations were reported; hazard ratio (HR) estimates with 95% confidential intervals (CIs) for OS were available.

RESULTS: Six clinical trials were included in this study. Pooled HR for OS of the EGFR-mutated population who completed sequential treatments was 1.03 (95%CI 0.86-1.22, P=0.776). There was no statistically significant heterogeneity between the studies (tau2=0; I2=0 with 95%CIs 0-0.37, P=0.548). Evidence of marked publication bias for the two treatment sequencings was insufficient (P=0.145).

CONCLUSIONS: In advanced NSCLC patients with activating EGFR mutations, first-line chemotherapy followed at progression by a TKI was not inferior in terms of OS compared with the inverse sequence. This may serve as an indication that chemotherapy could be employed initially if mutation testing results were unavailable.

CLINICAL IMPLICATIONS: Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) is a standard treatment for patients with activating EGFR mutations. To date, there are no direct comparative data between first-line and second-line EGFR TKI in these patients. Our meta-analysis provided evidence that for advanced NSCLC patients with activating EGFR mutations, first-line chemotherapy followed at progression by a TKI was not inferior in terms of OS compared with the inverse sequence of first-line TKI followed by chemotherapy. Our result suggested that chemotherapy could be employed initially if mutation testing results were unavailable, either immediately or at all.

DISCLOSURE: The following authors have nothing to disclose: Yiliang Zhang, Yihua Sun, Lei Wang, Ting Ye, Yunjian Pan, Haichuan Hu, Yongfu Yu, David Garfield, Haiquan Chen

No Product/Research Disclosure Information


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