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Original Research: Lung Cancer |

Efficacy of EGFR Tyrosine Kinase Inhibitors in the Adjuvant Treatment for Operable Non-small Cell Lung Cancer by a Meta-Analysis

Qingyuan Huang, MD; Jinhui Li, MSc; Yihua Sun, MD, PhD; Rui Wang, MD, PhD; Xinghua Cheng, MD, PhD; Haiquan Chen, MD, PhD
Author and Funding Information

Dr Huang and Ms Li contributed equally to this manuscript and share the first authorship.

FUNDING/SUPPORT: This work was supported by the National Natural Science Foundation of China (81330056, 81472173, 81401891, 81572253, and 81372525); the Key Project of Science and Technology Commission of Shanghai Municipality (JGGG1302); Shanghai Hospital Development Center (grant no. SHDC12012308), the Health and Family Planning Commission of Shanghai Municipality (grant no. 2013ZYJB0301), and the Science and Technology Commission of Shanghai Municipality (grant no. 14495810800).

CORRESPONDENCE TO: Haiquan Chen, MD, PhD, Department of Thoracic Surgery, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 241, West Huaihai Rd, Shanghai, 200030, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1384-1392. doi:10.1016/j.chest.2015.12.017
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Background  The role of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the adjuvant treatment of non-small cell lung cancer (NSCLC) has not been well-established. Our meta-analysis aimed to determine whether the administration of EGFR-TKIs could improve the outcomes of patients with NSCLC undergoing complete resection.

Methods  We comprehensively searched databases and extracted data from eligible studies. Disease-free survival (DFS) and overall survival (OS) with hazard ratios (HRs) as well as disease relapse with odds ratios (OR) were calculated using random and/or fixed-effects models. Meta-regression analysis and test for interaction between subgroups were also carried out.

Results  A total of 1,960 patients in five studies were included. Adjuvant EGFR-TKI treatment was associated with a significant benefit on DFS (HR, 0.63; 95% CI, 0.41-0.99), corresponding to an absolute benefit of 3.1% at 3 years, yet with significant heterogeneity (I2 = 83.4%, P < .001). The survival benefit was superior (Pinteraction = .03) in studies with more than an 18-month median treatment duration. EGFR mutation rate was also identified as a source of heterogeneity (P = .017). In the population with EGFR mutations, HR for DFS was 0.48 (95% CI, 0.36-0.65), corresponding to an absolute benefit of 9.5% at 3 years, with a reduced risk of distant metastasis (OR, 0.71; 95% CI, 0.56-0.92). Adjuvant EGFR-TKI treatment resulted in a marginally statistically significant benefit on OS (HR, 0.72; 95% CI, 0.49-1.06). The rate of overall grade 3 or greater adverse events was 42.3% (95% CI, 39.1-45.6).

Conclusions  Adjuvant EGFR-TKI treatment may enhance disease-free survival and reduce the risk of distant metastasis in patients with EGFR-mutant NSCLC undergoing complete resection.

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