Meta-Analysis Shows Increased Benefit of EGFR Tyrosine Kinase Inhibitors vs Chemotherapy in Subgroups of Patients With EGFR-Mutant NSCLC
In a meta-analysis reported in the Journal of Clinical Oncology, Lee et al found that increased progression-free survival benefit of EGFR tyrosine kinase inhibitor treatment vs chemotherapy was exhibited in patients with exon 19 deletion, never-smokers, and women.
Study Details
The meta-analysis included seven trials (N = 1,649) comparing EGFR tyrosine kinase inhibitors with chemotherapy in patients with newly diagnosed advanced EGFR-mutant disease. Overall, tyrosine kinase inhibitor therapy was associated with significantly prolonged progression-free survival (hazard ratio [HR] = 0.37, 95% confidence interval [CI] = 0.32–0.42).
Additional Benefit
Progression-free survival benefit was 50% greater in patients with exon 19 deletion vs those with exon 21 L858R substitution (HR = 0.24, 95% CI = 0.20–0.29, vs HR = 0.48, 95% CI = 0.39–0.58; P < .001 for interaction), 36% greater in never-smokers vs ever smokers (HR = 0.32, 95% CI = 0.27–0.37, vs HR = 0.50, 95% CI = 0.40–0.63; P < .001 for interaction), and 27% greater in women vs men (HR = 0.33, 95% CI = 0.28–0.38, vs HR = 0.45, 95% CI = 0.36–0.55; P = .02 for interaction). Additional benefit of tyrosine kinase inhibitor treatment was not significantly associated with performance status, age, ethnicity, or tumor histology.
The investigators concluded: “Although EGFR [tyrosine kinase inhibitors] significantly prolonged [progression-free survival] overall and in all subgroups, compared with chemotherapy, greater benefits were observed in those with exon 19 deletions, never-smokers, and women. These findings should enhance drug development and economic analyses, as well as the design and interpretation of clinical trials.”
James Chih-Hsin Yang, MD, PhD, of National Taiwan University College of Medicine, is the corresponding author for the Journal of Clinical Oncology article.
For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
