Systematic Review Of Gefitinib And Erlotinib For Treating Non-small-cell Lung Cancer: Screening Dominant Crowd

Epidermal growth factor receptor(EGFR) tyrosine kinase inhibitors(TKIs)-gefitinib and erlotinib is a targeted therapy drug for non-small cell lung cancer(NSCLC). There was evidence of a greater survival benefit from gefitinib and erlotinib in patients with certain molecular and clinical features, but results are conflicting. The aim of this study is to assess the role of these factors in gefitinib and erlotinib efficacy.Materials and methodsA systematic review of all the relevant randomized(RCTs) was performed. Searches were applied to the following electronic database:Cochrane Library, Pubmed, Embase, CBM, CNKI and Wanfang Date, and add hand search. The included studies, we performed assessment of studies quality and data extraction. StatalO software was used for meta-analysis.ResultsEight RCTs were analyzed. Non-smokers get more benefit from gefitinib and erlotinib [Median Survival Time(MST), Non smokers:HR=0.52,95%CI(0.31,0.86); Smokers:HR=0.91,95%CI(0.81,1.02);Progression-free survival(PFS), Non smokers: HR=0.55,95%CI(0.42,0.72); Smokers:HR=0.89,95%CI(0.78,1.01); Reponse Rate(RR), Non smokers:OR=27.58,95%CI(5.40,140.72); Smokers:OR=4.57, 95%CI(2.07,10.07)]; Patients with positive EGFR expression had a lower relative risk of death[MST, HR=0.79,95%CI(0.65,0.97)]; There was a positive effect of TKIs on PFS in patients whose tumours had a high EGFR gene copy number[HR=0.55, 95%CI(0.40,0.75)]; Patients with positive EGFR(19,21) mutations are benefit on RR[OR=4.08,95%CI(1.14,14.68)]; K-ras mutations are unfit for TKIs [MST, K-ras+ HR=1.97,95%CI(1.16,3.33);PFS,K-ras+:HR=1.90,95%CI(1.05,3.44)].ConclusionBased on the present evidence, non-smokers get more benefit from gefitinib and erlotinib, and K-ras mutations are unfit for gefitinib and erlotinib. Results of prospective randomized trials are awaited.