Yang, Z;
Hackshaw, A;
Feng, Q;
Fu, X;
Zhang, Y;
Mao, C;
Tang, J;
(2017)
Comparison of gefitinib, erlotinib and afatinib in non-small cell lung cancer: A meta-analysis.
International Journal of Cancer
, 140
(12)
pp. 2805-2819.
10.1002/ijc.30691.
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Abstract
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 EGFR 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 EGFR-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.
| Type: | Article |
|---|---|
| Title: | Comparison of gefitinib, erlotinib and afatinib in non-small cell lung cancer: A meta-analysis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/ijc.30691 |
| Publisher version: | https://doi.org/10.1002/ijc.30691 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | afatinib, erlotinib, gefitinib, meta-analysis, non-small cell lung cancer, Carcinoma, Non-Small-Cell Lung, Diarrhea, Disease-Free Survival, Erlotinib Hydrochloride, Exanthema, Humans, Lung Neoplasms, Mutation, Outcome Assessment (Health Care), Proportional Hazards Models, Protein Kinase Inhibitors, Quinazolines, Randomized Controlled Trials as Topic, Receptor, Epidermal Growth Factor |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10062664 |
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