Multitargeted antiangiogenic tyrosine kinase inhibitors in combination with chemotherapy in patients with advanced non-small cell lung cancer: A Meta-analysis / 肿瘤

ABSTRACT

Objective: To evaluate the efficacy and safety of chemotherapy alone or combined with multitargeted antiangiogenic TKI (tyrosine kinase inhibitor) for patients with advanced NSCLC (non-small cell lung cancer). Methods: A computer-based online search was performed by using EMBASE, Cochrane Library, PubMed, CNKI (China National Knowledge Infrastructure), Wanfang and VIP databases and Chinese Biomedical Literature Database. Studies of RCT (randomized controlled trial) in accordance with the inclusion and exclusion criteria were included. Quality of the studies was assessed using Jadad score. Data were extracted from the studies by 2 independent reviewers. The Meta-analysis was performed by Stata 12.0 software. Results: Nine RCTs (totally 5 286 patients) were eligible. Meta-analysis showed that there was significant improvement in ORR (objective response rate) [OR (odds ratio) 1.51, 95% CI (confidence interval) 1.21-1.87, P = 0.000] and PFS (progression-free survival) [HR (hazard ratio) 0.83, 95% CI 0.77-0.88, P = 0.000) in multitargeted antiangiogenic TKI plus chemotherapy group, as compared with chemotherapy along group. Though the pooled HR (HR = 0.94, 95% CI 0.87-1.01, P = 0.081) for OS (overall survival) showed no significant difference between the two groups. However, there were higher rates of diarrhea (OR 2.09, 95% CI 1.48-2.96, P = 0.000), rash (OR 2.30, 95% CI 1.59-3.29, P = 0.000), hypertension (OR 3.30, 95% CI 2.69-4.06, P = 0.000), hemorrhage (OR 1.49, 95% CI 1.07-2.06, P = 0.018), anorexia (OR 1.45, P = 1.01-2.07, P = 0.042), stomatitis (OR 2.13, 95% CI 1.29-3.52, P = 0.003) and hand-foot skin reaction (OR 4.55, 95% CI 1.77-11.71, P = 0.002). Conclusion: In comparison with chemotherapy alone, multitargeted antiangiogenic TKI plus chemotherapy had better therapeutic effects on NSCLC. Meanwhile, it also increases the rates of adverse effects such as diarrhea, rash, hypertension, hemorrhage, anorexia, stomatitis and hand-foot skin reaction, which should be prevented and symptomatically treated. Copyright © 2013 by TUMOR.