Objective: to systematically evaluate and compare the efficacy and safety of 14 treatment options in patients with EGFR 19DEL mutation and EGFR 21L858R mutation in non-small cell lung cancer. Methods: the Pubmed, Coch...Objective: to systematically evaluate and compare the efficacy and safety of 14 treatment options in patients with EGFR 19DEL mutation and EGFR 21L858R mutation in non-small cell lung cancer. Methods: the Pubmed, Cochrane, Embase database and ASCO, ESMO, and WCLC conferences were retrieved to collect clinical randomized controlled trials (RCT) of first-line EGFR-related non-small cell lung cancer with TKIs. Based on the grouping of EGFR mutation types, Bayesian mesh meta-analysis (NMA) was performed by using GEMTC package Markov chain Monte Carlosimulation with R software, comparing the difference between progression-free survival (PFS) and grade 3 or above adverse reactions (≥3AES) in EGFR 19DEL and EGFR 21L858R mutations in patients with each treatment regimen. In addition, the efficacy and safety of the 14 treatment options were ranked according to the cumulative area of SUCRA (EGFR mutation type).Results: a total of 22 RCTs were included in the study, involving 14 treatment regimens. NMA results showed that for patients with EGFR 19DEL mutation, all EGFR TKIs related treatment schemes could prolong PFS more than chemotherapy, especially AUM and OSI (AUM vs PB:HR 0.17, 95%CI 0.08 ~ 0.35;OSI vs PB:HR 0.18, 95%CI 0.08 ~ 0.38);For patients with EGFR 21L858R mutation, GEF+PB and OSI could prolong PFS most (GEF+PB vs PB:HR 0.30, 95%CI 0.14 ~ 0.56;OSI vs PB:HR 0.35, 95%CI 0.15 ~ 0.74). Sucra ranking results showed that for patients with EGFR 19DEL mutation, AUM, OSI, GEF+PB ranked first, second and third in PFS respectively, while for patients with EGFR 21L858R mutation, the top three schemes were GEF+PB, OSI and ERL+BEV respectively. Conclusion: AUM and GEF+PB are the best treatment options for patients with EGFR 19DEL mutation and EGFR 21L858R mutation, respectively.展开更多
文摘Objective: to systematically evaluate and compare the efficacy and safety of 14 treatment options in patients with EGFR 19DEL mutation and EGFR 21L858R mutation in non-small cell lung cancer. Methods: the Pubmed, Cochrane, Embase database and ASCO, ESMO, and WCLC conferences were retrieved to collect clinical randomized controlled trials (RCT) of first-line EGFR-related non-small cell lung cancer with TKIs. Based on the grouping of EGFR mutation types, Bayesian mesh meta-analysis (NMA) was performed by using GEMTC package Markov chain Monte Carlosimulation with R software, comparing the difference between progression-free survival (PFS) and grade 3 or above adverse reactions (≥3AES) in EGFR 19DEL and EGFR 21L858R mutations in patients with each treatment regimen. In addition, the efficacy and safety of the 14 treatment options were ranked according to the cumulative area of SUCRA (EGFR mutation type).Results: a total of 22 RCTs were included in the study, involving 14 treatment regimens. NMA results showed that for patients with EGFR 19DEL mutation, all EGFR TKIs related treatment schemes could prolong PFS more than chemotherapy, especially AUM and OSI (AUM vs PB:HR 0.17, 95%CI 0.08 ~ 0.35;OSI vs PB:HR 0.18, 95%CI 0.08 ~ 0.38);For patients with EGFR 21L858R mutation, GEF+PB and OSI could prolong PFS most (GEF+PB vs PB:HR 0.30, 95%CI 0.14 ~ 0.56;OSI vs PB:HR 0.35, 95%CI 0.15 ~ 0.74). Sucra ranking results showed that for patients with EGFR 19DEL mutation, AUM, OSI, GEF+PB ranked first, second and third in PFS respectively, while for patients with EGFR 21L858R mutation, the top three schemes were GEF+PB, OSI and ERL+BEV respectively. Conclusion: AUM and GEF+PB are the best treatment options for patients with EGFR 19DEL mutation and EGFR 21L858R mutation, respectively.
