EGFR-TKI plus anti-angiogenic drugs in EGFR-mutated NSCLC: a meta-analysis of randomized clinical trials
A partir d'une revue systématique de la littérature (5 essais cliniques), cette méta-analyse évalue le bénéfice, en termes de survie sans progression, de l'ajout d'un agent anti-angiogenèse à un inhibiteur de tyrosine kinase du récepteur EGFR chez les patients atteints d'un cancer du poumon non à petites cellules avec récepteur EGFR muté
Résumé en anglais
Background : Results of several RCTs testing the combination of an EGFR-TKI plus an anti-angiogenic drug in advanced EGFR-mutated NSCLC were reported.
Methods : We first report a systematic-review and meta-analysis of all RCTs, to estimate effectiveness and toxicity of such new therapeutic approach as compared with first-generation EGFR-TKIs monotherapy. Subsequently, we present a network meta-analysis (NMA) comparing the combination of an EGFR-TKI plus an anti-angiogenic drug with other two new treatment-options: combination of an EGFR-TKI plus chemotherapy or new EGFR-TKIs of second or third generation as monotherapy.
Results : Five RCTs were included in the first meta-analysis. The PFS was statistically significantly larger in patients treated with an EGFR-TKI plus an anti-angiogenic drug as compared with EGFR-TKI monotherapy: the pooled PFS-HR was 0.59 (95% CI = 0.51 to 0.69). The pooled median-PFS was 17.8 months (95% CI = 16.5 to 19.3) for the combination versus 11.7 months (95% CI = 11.1 to 12.7) for EGFR-TKI as monotherapy. No statistically significant differences between the two treatment-arms were observed in terms of both OS and ORR. The rate of grade equal or higher than 3 AEs was statistically significantly higher in patients treated with EGFR-TKI plus an anti-angiogenic drug: the pooled-Relative Risk was 1.72 (95% CI = 1.43 to 2.06). Ten RCTs were included in the NMA. All the three experimental treatments were associated with a statistically significant improvement of PFS as compared with first-generation EGFR-TKIs. When compared to each other, none of the three experimental treatments was statistically significantly associated with larger PFS or lower rate of grade
