文献类型：期刊文献

英文题名：A meta-analysis of the comparing of the first-generation and next-generation TKIs in the treatment of NSCLC

作者：Li, Yongxing[1];Yang, Jianye[1];Xu, Yufen[2];Zhang, Ming[3];Zhang, Xiaoping[4];Chen, Wenyu[3];Lv, Xiaodong[3]

机构：[1]Shaoxing Univ, Affiliated Hosp, Shaoxing Municipal Hosp, Dept Respirat, Shaoxing 312000, Zhejiang, Peoples R China;[2]Jiaxing Univ, Affiliated Hosp 1, Hosp Jiaxing 1, Dept Oncol, Jiaxing 314000, Zhejiang, Peoples R China;[3]Jiaxing Univ, Affiliated Hosp 1, Hosp Jiaxing 1, Dept Respirat, Jiaxing 314000, Zhejiang, Peoples R China;[4]Jiaxing Univ, Affiliated Hosp 1, Hosp Jiaxing 1, Div Sci & Educ, Jiaxing 314000, Zhejiang, Peoples R China

年份：2019

卷号：16

期号：5

起止页码：5687

外文期刊名：MATHEMATICAL BIOSCIENCES AND ENGINEERING

收录：SCI-EXPANDED(收录号：WOS:000472872700100)、、EI(收录号：20201308349198)、Scopus(收录号：2-s2.0-85070501616)、WOS

基金：This study was supported by the Funds from The Key Discipline of Jiaxing Respiratory Medicine Construction Project, The Early Diagnosis and Comprehensive Treatment of Lung Cancer Innovation Team Building Project, Science and technology project of Jiaxing (2015AY23016, 2016AY23086) and Talent Cultivation in Science and Technology Innovation Project of The First Hospital of Jiaxing (No. 2016-CX-04. 2016-CX-05).

语种：英文

外文关键词：NSCLC; first-generation EGFR-TKIs; second/third-generation EGFR-TKIs; meta-analysis

外文摘要：Background: The current standard approach to the treatment of patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)-sensitizing mutations has been the treatment with a first-generation EGFR-TKIs. While, with resistance developed against first-generation EGFR-TKIs, second/third-generation TKIs have attracted all the attention, and replaced first-generation EGFR- TKIs upon disease progression due to the greater efficacy and more favorable tolerability. In the past few years, this strategy has been challenged by clinical evidence when next-generation EGFR-TKIs are used in patients with advanced NSCLC. Objective: In this study, we performed a meta- analysis to investigate the efficacy of next-generation TKIs comparison with first-generation TKIs in the treatment of NSCLC. Methods: The multiple databases including Pubmed, Embase, Cochrane library databases were adopted to search for the relevant studies, and full-text articles involving to comparison of next-generation TKIs and first-generation TKIs were reviewed. After rigorous reviewing on quality, the data was extracted from eligible randomized controlled trial (RC T). Meta-analysis Revman 5.3 software was used to analyze the combined pooled ORs with the corresponding 95% confidence interval using fixed- or random-effects models according to the heterogeneity. Results: A total of 5 randomized controlled trials were included in this analysis. The group of next-generation TKIs did achieved benefit in progression-free survival (PFS) (OR = 0.58, 95%CI = 0.45-0.75, P<0.0001), overall survival (OS) (OR = 0.76, 95%CI = 0.65-0.90, P = 0.001) as well with the objective response rate (ORR) (OR = 1.27, 95%CI = 1.01-1.61, P = 0.04), respectively. In the results of subgroup analysis of PFS with EGFR mutations, there is also significant differences with exon 19 deletion (OR = 0.56, 95%CI = 0.41-0.77, P = 0.0003) and exon 21 (L858R) mutation (OR = 0.60, 95%CI = 0.49-0.75, P<=0.00001). While, the treatment-related severe adverse event (SAE) between the next-generation TKIs and first-generation TKIs did not have statistical significance (OR = 1.48, 95%CI = 0.62-3.55, P = 0.38). Conclusion: The next-generation TKIs significantly improved efficacy outcomes in the treatment of EGFR mutation-positive advanced NSCLC compared with the first-generation TKIs, with a manageable safety profile. These results are potentially important for clinical decision making for these patients.