The safety and efficacy of gefitinib versus platinum-based doublets chemotherapy as the first-line treatment for advanced non-small-cell lung cancer patients in East Asia: A meta-analysis
Journal
Lung Cancer
Journal Volume
62
Journal Issue
2
Pages
242-252
Date Issued
2008
Author(s)
Abstract
Background: To evaluate the risk/benefit profiles of gefitinib in comparison with platinum-based doublets chemotherapy as a first-line treatment for chemona?ve patients with advanced non-small-cell lung cancer in East Asia. Methods: We searched MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov to identify randomized and non-randomized phase II or III clinical trials of gefitinib or chemotherapy treatment in East Asian patients published before 4/30/2007. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Treatment arms with gefitinib 250 mg/day and platinum-based doublets chemotherapy irrespective of dosage and schedule were combined to calculate the pooled estimates for efficacy and safety outcomes of interest. Results: We identified 7 gefitinib and 41 platinum-based doublets chemotherapy trials with nearly 3000 enrolled patients for planned comparison. The pooled response rate (95% confidence interval) to gefitinib for unselected chemona?ve population was 31% (23-38%), not substantially different from 34% (31-38%) reported by platinum-based doublets chemotherapy trials. Patients with certain characteristics were more likely to benefit from gefitinib treatment, with pooled response rates as high as 75% (60-90%) for patients with epidermal growth factor receptor (EGFR) exon 18-21 mutations; 56% (38-74%) for never smokers; 55% (41-69%) for female; and 43% (30-57%) for adenocarcinoma or bronchioalveolar carcinoma. Severe hematological adverse events related to gefitinib treatment were not observed in any of the included trials. However, the risks of severe liver and lung injury related to gefitinib treatment were both approximately 6%, significantly higher than 1% and 0.2% reported by platinum-based doublets chemotherapy trials. Conclusion: Our data suggest that one third of chemona?ve NSCLC patients in East Asia would respond to oral gefitinib monotherapy while 6% would develop severe liver and lung injury. Although patients with EGFR gene mutations, female gender, non-smokers, or adenocarcinoma were more likely to respond to gefitinib, further study with valid comparison groups are needed to identify the optimal treatment strategy in these subpopulations. ? 2008 Elsevier Ireland Ltd. All rights reserved.
SDGs
Other Subjects
carboplatin; cisplatin; docetaxel; epidermal growth factor receptor; gefitinib; gemcitabine; irinotecan; navelbine; paclitaxel; aminotransferase blood level; anemia; area under the curve; article; Asia; cancer inhibition; cancer patient; cancer survival; clinical trial; Cochrane Library; drug efficacy; drug safety; EMBASE; exon; follow up; gene mutation; hematologic disease; human; interstitial lung disease; large cell carcinoma; leukopenia; liver injury; liver toxicity; lung adenocarcinoma; lung alveolus cell carcinoma; lung fibrosis; lung injury; lung non small cell cancer; lung toxicity; MEDLINE; meta analysis; monotherapy; neutropenia; priority journal; side effect; squamous cell carcinoma; survival rate; survival time; systematic review; thrombocytopenia; treatment outcome; treatment response; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Far East; Female; Humans; Lung Neoplasms; Male; Platinum Compounds; Quinazolines
Type
journal article