Comparison of gefitinib, erlotinib and afatinib in non‐small cell lung cancer: A meta‐analysis

  • Zuyao Yang
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China
  • Allan Hackshaw
    Cancer Research UK and University College London Cancer Trials Centre 90 Tottenham Court Rd London W1T 4TJ United Kingdom
  • Qi Feng
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China
  • Xiaohong Fu
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China
  • Yuelun Zhang
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China
  • Chen Mao
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China
  • Jinling Tang
    Division of Epidemiology the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong Hong Kong China

抄録

<jats:p>Gefitinib, erlotinib and afatinib are three widely used epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) for treating advanced non‐small cell lung cancer (NSCLC) with proven efficacy. We undertook a systematic review and meta‐analysis to synthesize existing studies with direct comparisons of EGFR TKIs in NSCLC in terms of both efficacy and safety. Eight randomized trials and 82 cohort studies with a total of 17,621 patients were included for analysis. Gefitinib and erlotinib demonstrated comparable effects on progression‐free survival (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.95 to 1.04), overall survival (HR, 0.99; 95% CI, 0.93 to 1.06), overall response rate (risk ratio [RR], 1.05; 95% CI, 1.00 to 1.11), and disease control rate (RR, 0.98; 95% CI, 0.96 to 1.01), which did not vary considerably with <jats:italic>EGFR</jats:italic> mutation status, ethnicity, line of treatment, and baseline brain metastasis status. Gefitinib was associated with more grade 3/4 liver dysfunction, but tended to cause lower rates of dose reduction, treatment discontinuation, total grade 3/4 adverse events (RR, 0.78; 95% CI 0.65 to 0.94), and a number of specific adverse events such as rash and diarrhea. No solid evidence was found that afatinib had greater efficacy than gefitinib or erlotinib in first‐line treatment of <jats:italic>EGFR</jats:italic>‐mutant NSCLC. However, afatinib was more effective than erlotinib as second‐line treatment of patients with advanced squamous cell carcinoma. The grade 3/4 adverse events rate of afatinib was comparable to that of erlotinib but higher than that of gefitinib.</jats:p>

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