Do patient characteristics affect EGFR tyrosine kinase inhibitor treatment outcomes? A network meta-analysis of real-world survival outcomes of East Asian patients with advanced non-small cell lung cancer treated with first-line EGFR-TKIs

• Published in: Thoracic cancer 2023-11, Vol.14 (32), p.3208-3216
• Main Authors: Chang, Huang-Chih, Wang, Chin-Chou, Tseng, Chia-Cheng, Huang, Kuo-Tung, Chen, Yu-Mu, Chang, Yu-Ping, Lai, Chien-Hao, Fang, Wen-Feng, Lin, Meng-Chih, Chuang, Hung-Yi
• Format: Article
• Language: English
• Subjects: Afatinib - therapeutic use; Asian people; Brain Neoplasms - drug therapy; Brain Neoplasms - genetics; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - genetics; Carcinoma, Non-Small-Cell Lung - pathology; Chemotherapy; Clinical outcomes; Clinical trials; East Asian People; Epidermal growth factor; ErbB Receptors; Erlotinib Hydrochloride - pharmacology; Erlotinib Hydrochloride - therapeutic use; first‐line EGFR‐TKI; Gefitinib - therapeutic use; Humans; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - genetics; Lung Neoplasms - pathology; Meta-analysis; Metastasis; Mutation; Network Meta-Analysis; non‐small cell lung cancer; Observational studies; Older people; Oncology; Original; overall survival; Patients; Protein Kinase Inhibitors - pharmacology; Protein Kinase Inhibitors - therapeutic use; Search strategies; Survival analysis; Treatment Outcome; Tyrosine Kinase Inhibitors
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.15111

Despite the well-established efficacies of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC), there is limited real-world evidence comparing their effectiveness according to patients' clinical characteristics. This network meta-analysis (NMA) compared survival outcomes among first-line EGFR-TKIs in different subgroups of East Asian patients with advanced NSCLC. This NMA included real-world observational studies reporting outcomes with TKIs in patients aged >65 years, with baseline brain metastasis, with different Eastern Cooperative Oncology Group (ECOG) statuses, or with different common EGFR mutation types. In patients with the EGFR L858R mutation, afatinib resulted in significantly longer progression-free survival (PFS) than erlotinib (hazard ratio [HR]: 0.59, 95% confidence interval [CI]: 0.46-0.75) and gefitinib (HR: 0.41, 95% CI: 0.32-0.53). Similarly, in patients with the EGFR Del19 mutation, afatinib and erlotinib resulted in significantly longer PFS than gefitinib (HR: 0.48 with 95% CI: 0.33-0.71 and HR: 0.54 with 95% CI: 0.36-0.80, respectively). Moreover, afatinib resulted in significantly longer PFS than gefitinib in patients with brain metastasis (HR: 0.53, 95% CI: 0.33-0.87) or ECOG status 0-1 (HR: 0.37, 95% CI: 0.23-0.59). This NMA suggests that afatinib results in similar PFS to erlotinib and superior PFS than gefitinib in patients with Del19 mutant NSCLC, aged ≥65 years, with ECOG scores of 0-1, and with baseline brain metastasis.