Abstract
We performed a systematic review and meta-analysis to assess the potential of erlotinib plus platinum-based chemotherapy relative to platinum-based chemotherapy alone for advanced non-small-cell lung cancer (NSCLC). Search of PubMed, EMBASE, Web of Science, CBM, CNKI, China Wan Fang databases and the Cochrane library was performed for studies regarding erlotinib plus platinum-based chemotherapy for advanced NSCLC published between 1 January 2000 and 28 August 2014. We identified eight eligible studies including 3,363 patients with advanced NSCLC. For PFS measure, an HR of 0.73 (0.58–0.93) with statistical significance was estimated when erlotinib plus platinum-based chemotherapy compared with platinum-based chemotherapy alone; objective response rate of 32.86 versus 24.85 % was obtained for both groups, respectively. HR of 0.93 (0.86–1.00) with P of 0.170 was calculated for OS. We concluded that the erlotinib plus chemotherapy for advanced NSCLC could increase PFS and objective response rate, but not benefit OS.
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References
Chen WQ, Zheng RS, Zhang SW, Zeng HM, Zou XN. The incidences and mortalities of major cancers in China, 2010. Chin J Cancer. 2014;33(8):402–5. doi:10.5732/cjc.014.10084.
Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2014. doi:10.1016/S0140-6736(14)62038-9.
Wu YL, Lee JS, Thongprasert S, Yu CJ, Zhang L, Ladrera G, et al. Intercalated combination of chemotherapy and erlotinib for patients with advanced stage non-small-cell lung cancer (FASTACT-2): a randomised, double-blind trial. Lancet Oncol. 2013. doi:10.1016/S1470-2045(13)70254-7.
Bezjak A, Tu D, Seymour L, Clark G, Trajkovic A, Zukin M, et al. Symptom improvement in lung cancer patients treated with erlotinib: quality of life analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol. 2006;24(24):3831–7. doi:10.1200/jco.2006.05.8073.
Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123–32. doi:10.1056/NEJMoa050753.
http://www.cancer.gov/cancertopics/druginfo/fda-erlotinibhydrochloride. 19 Aug 2014.
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#nscl,version.4,2014.55–56.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi:10.1136/bmj.b2535.
Spruance SL, Reid JE, Grace M, Samore M. Hazard ratio in clinical trials. Antimicrob Agents Chemother. 2004;48(8):2787–92. doi:10.1128/AAC.48.8.2787-2792.2004.
Tarro G, Perna A, Esposito C. Early diagnosis of lung cancer by detection of tumor liberated protein. J Cell Physiol. 2005;203(1):1–5. doi:10.1002/jcp.20195.
Julian PT Higgins SG. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011] Chapter 8: Assessing risk of bias in included studies. 2011.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. doi:10.1136/bmj.d5928.
Schünemann HJ, Oxman A. GRADE handbook for grading the quality of evidence and the strength of recommendations Version 3.2 [updated March 2009]. 2009.
Deeks JJ, Altman DG. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011] Chapter 9: Analysing data and undertaking meta-analyses. 2011.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. doi:10.1002/sim.1186.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. doi:10.1136/bmj.327.7414.557.
Egger M, Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.
Xu YH, Lu S. A meta-analysis of STAT3 and phospho-STAT3 expression and survival of patients with non-small-cell lung cancer. Eur J Surg Oncol. 2014;40(3):311–7.
Lee DH, Lee JS, Kim SW, Rodrigues-Pereira J, Han B, Song XQ, et al. Three-arm randomised controlled phase 2 study comparing pemetrexed and erlotinib to either pemetrexed or erlotinib alone as second-line treatment for never-smokers with non-squamous non-small cell lung cancer. Eur J Cancer. 2013;49(15):3111–21.
Boutsikou E, Kontakiotis T, Zarogoulidis P, Darwiche K, Eleptheriadou E, Porpodis K, et al. Docetaxel–carboplatin in combination with erlotinib and/or bevacizumab in patients with non-small cell lung cancer. Onco Targets Ther. 2013;6:125–34.
Stinchcombe TE, Peterman AH, Lee CB, Moore DT, Beaumont JL, Bradford DS, et al. A randomized phase II trial of first-line treatment with gemcitabine, erlotinib, or gemcitabine and erlotinib in elderly patients (age>/=70 years) with stage IIIB/IV non-small cell lung cancer. J Thorac Oncol. 2011;6(9):1569–77. doi:10.1097/JTO.0b013e3182210430.
Cappuzzo F, Ciuleanu T, Stelmakh L, Cicenas S, Szczesna A, Juhasz E, et al. Erlotinib as maintenance treatment in advanced non-small-cell lung cancer: a multicentre, randomised, placebo-controlled phase 3 study. Lancet Oncol. 2010;11(6):521–9.
Mok TSK, Wu YL, Yu CJ, Zhou C, Chen YM, Zhang L, et al. Randomized, placebo-controlled, phase II study of sequential erlotinib and chemotherapy as first-line treatment for advanced non-small-cell lung cancer. J Clin Oncol. 2009;27(30):5080–7.
Gatzemeier U, Pluzanska A, Szczesna A, Kaukel E, Roubec J, De Rosa F, et al. Phase III study of erlotinib in combination with cisplatin and gemcitabine in advanced non-small-cell lung cancer: the Tarceva lung cancer investigation trial. J Clin Oncol. 2007;25(12):1545–52.
Herbst RS, Prager D, Hermann R, Fehrenbacher L, Johnson BE, Sandler A, et al. TRIBUTE: a phase III trial of erlotinib hydrochloride (OSI-774) combined with carboplatin and paclitaxel chemotherapy in advanced non-small-cell lung cancer. J Clin Oncol. 2005;23(25):5892–9.
Kelly K, Azzoli CG, Zatloukal P, Albert I, Jiang PY, Bodkin D, et al. Randomized phase 2b study of pralatrexate versus erlotinib in patients with stage IIIB/IV non-small-cell lung cancer (NSCLC) after failure of prior platinum-based therapy. J Thorac Oncol. 2012;7(6):1041–8. doi:10.1097/JTO.0b013e31824cc66c.
Lee J-K, Hahn S, Kim D-W, Suh KJ, Keam B, Kim TM, et al. Epidermal growth factor receptor tyrosine kinase inhibitors vs conventional chemotherapy in non-small cell lung cancer harboring wild-type epidermal growth factor receptor: a meta-analysis. JAMA. 2014;311(14):1430–7.
Haaland B, Tan PS, de Castro Jr G, Lopes G. Meta-analysis of first-line therapies in advanced non-small-cell lung cancer harboring EGFR-activating mutations. J Thorac Oncol. 2014;9(6):805–11.
Zhang Y, Sun Y, Wang L, Ye T, Pan Y, Hu H, et al. Sequential treatment of tyrosine kinase inhibitors and chemotherapy for EGFR-mutated non-small cell lung cancer: a meta-analysis of phase III trials. Chest. 2014;145(3 Suppl):348A.
Zhao N, Zhang X-C, Yan H-H, Yang J-J, Wu Y-L. Efficacy of epidermal growth factor receptor inhibitors versus chemotherapy as second-line treatment in advanced non-small-cell lung cancer with wild-type EGFR: a meta-analysis of randomized controlled clinical trials. Lung Cancer (Amsterdam, Netherlands). 2014;85(1):66–73.
Acknowledgments
The authors thank the reviewers for their helpful comments on this article. This work was supported by NSFC (Natural Science Foundation of China) (81360351), Start-Up Fund for Doctor of Zunyi Medical University and the Department of Science and Technology of Guizhou Province (Grant No. Qian Ke He SY [2013] 3003).
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The authors have declared no conflicts of interest.
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Jian-Guo Zhou, Xu Tian and Xue Wang have contributed equally to this work.
Appendix: PubMed search terms
Appendix: PubMed search terms
#1 Search (((((((((Carcinoma, Non Small Cell Lung[Title/Abstract]) OR Carcinomas, Non Small Cell Lung[Title/Abstract]) OR Lung Carcinoma, Non-Small-Cell[Title/Abstract]) OR Lung Carcinomas, Non-Small-Cell[Title/Abstract]) OR Non-Small-Cell Lung Carcinomas[Title/Abstract]) OR Non small Cell Lung Cancer[Title/Abstract]) OR Non-Small-Cell Lung Carcinoma[Title/Abstract]) OR Carcinoma, Non-Small Cell Lung[Title/Abstract]) OR Non-Small Cell Lung Cancer[Title/Abstract]) OR “Carcinoma, Non-Small-Cell Lung”[Mesh].
#2 Search ((((((((((((OSI-774[Title/Abstract]) OR CP-358774[Title/Abstract]) OR CP-358,774[Title/Abstract]) OR CP 358,774[Title/Abstract]) OR CP 358774[Title/Abstract]) OR Tarceva[Title/Abstract]) OR 11C-erlotinib[Title/Abstract]) OR erlotinib HCl[Title/Abstract]) OR erlotinib hydrochloride[Title/Abstract]) OR N-(3-ethynylphenyl)-6,7-bis(2-methoxyethoxy)quinazolin-4-amine[Title/Abstract]) OR erlotinib[Title/Abstract])) OR “erlotinib” [Supplementary Concept].
#3 Search (((“Controlled Clinical Trial” [Publication Type]) OR (“Randomized Controlled Trials as Topic”[Mesh] OR “Randomized Controlled Trial” [Publication Type] OR “Controlled Clinical Trials as Topic”[Mesh]))) OR ((((((Controlled Clinical Trial[Title/Abstract]) OR Controlled Clinical Trials, Randomized[Title/Abstract]) OR Clinical Trials, Randomized[Title/Abstract]) OR Trials, Randomized Clinical[Title/Abstract]) OR Controlled Clinical Trials[Title/Abstract]) OR random*[Title/Abstract]).
#4: #1 AND #2 AND #3.
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Zhou, JG., Tian, X., Wang, X. et al. Treatment on advanced NSCLC: Platinum-based chemotherapy plus erlotinib or platinum-based chemotherapy alone? A systematic review and meta-analysis of randomised controlled trials. Med Oncol 32, 23 (2015). https://doi.org/10.1007/s12032-014-0471-0
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DOI: https://doi.org/10.1007/s12032-014-0471-0