Efficacy and safety of angiogenesis inhibitor combined with erlotinib in the targeted treatment of EGFR-mutated advanced non-small cell lung carcinoma:a Meta-analysis / 肿瘤

ABSTRACT

Objective:To evaluate the efficacy and safety of angiogenesis inhibitor combined with erlotinib versus erlotinib alone in the targeted treatment of epidermal growth factor receptor(EGFR)-mutated advanced non-small cell lung carcinoma. Methods:A computer-based online search was performed using PubMed,Cochrane Library,Excerpta Medica Database(Embase),Web of Science,VIP,China National Knowledge Infrastructure(CNKI),and WANFANG databases.The retrieval time is from the establishment of the database to March 2022.After literature screening and rigorous data extraction,Meta-analysis was performed using RevMan 5.4 software.The primary endpoints of this study were median progression free survival(mPFS),median overall survival(mOS),objective response rate(ORR)and safety. Results:A total of 11 articles containing data of 3 805 patients was included in this study.Meta-analysis results showed that compared with the treatment of erlotinib alone(control group),the treatment of angiogenesis inhibitors combined with erlotinib(experimental group)could effectively improve the mPFS[hazard ratio(HR)=0.64,95％confidence interval(CI)=0.58-0.70,P＜0.000 01]and ORR[odds ratio(OR)=1.2 5,95％CI=1.02-1.54,P=0.03]in advanced non-small cell lung cancer patients,while it did not show an advantage in improving mOS(HR=0.91,95％CI=0.78-1.07,P=0.26)and the difference was not statistically significant.In terms of safety,adverse events(AE)of grade 3 and above are higher in experimental group than that in control group(OR=2.09,95％CI=1.70-2.58,P＜0.00001),the experimental group had a higher rate of hypertension(OR=5.48,95％CI=2.78-1 0.8,P＜0.000 01),dermatitis acneiform and rash(OR=2.27,95％CI=1.33-3.89,P=0.003),diarrhea(OR=3.78,95％CI=2.13-6.69,P＜0.000 01),and proteinuria(OR=5.71,95％CI=1.73-18.82,P=0.004).There was no statistically significant difference in bleeding events(OR=1.37,95％CI=0.79-2.38,P=0.26)or hepatic injury(OR=1.08,95％CI=0.77-1.52,P=0.65)between the 2 groups. Conclusion:Compared with erlotinib alone,the combination of angiogenesis inhibitors could effectively improve the ORR and mPFS in patients with EGFR-mutated advanced non-small cell lung cancer.However,the combination of angiogenesis inhibitors with erlotinib increased the incidence of several grade 3 treatment-related AE,such as hypertension,dermatitis acneiform and rash,diarrhea,and proteinuria,compared to erlotinib treatment alone.