| Objective: Due to the controversy of clinical effect for non-small cell lung cancer treated by gefitinib?erlotinib and icotinib,a network meta-analysis was performed to compare the effectiveness and adverse effects of the drugs for patients with non-small cell lung cancer,so as to provide the reference for the clinical practice.Methods: Two reviewers searched the Cochrane,PubMed,EMbase,Sciencedirect,CNKI,WANFANG,and VIP databases for studies.Studies are then screened,evaluated and data extracted.End-points included complete response(CR),partial response(PR),stable disease(SD),progressive disease(PD),overall response rate(ORR),disease control rate(DCR),progression-free survival(PFS),median survival time(MST),and adverse effects.Included adverse effects were rash,diarrhea,nausea,vomiting,fatigue and abnormal liver functions.For the analysis of incorporated studies we used Rev Man 5.2?R 3.3.0 and Stata 13.0 software.Results: 43 studies and 7168 patients were included.There were no significant differences in CR?PR?SD?PD?ORR and DCR by performing the network meta-analysis.The results of comparison with gefitinib and erlotinib showed that erlotinib had higher rate of nausea and vomiting(OR = 2.0,95%Cr I: 1.1-3.7)than that of gefitnib by network meta-analysis.However,the rate of rash?diarrhea?fatigue and abnormal liver functions were no significant differences.Compared with erlotinib,gefitinib had got lower SD(OR = 0.86,95% CI:0.75-0.99,P =0.04)and lower rash(OR = 0.45,95% CI:0.36-0.55,P < 0.05),diarrhea(OR = 0.75,95% CI:0.61 – 0.92,P = 0.005),nausea vomiting(OR = 0.47,95% CI:0.27-0.84,P = 0.01)and fatigue(OR = 0.43,95% CI:0.24-0.76,P = 0.004).However,gefitinib had higher frequency of rash than icotinib(OR = 1.57,95% CI: 1.18-2.09,P = 0.002).There were no significant differences in CR?PR?PD?ORR? DCR and abnormal liver functions among the drugs by meta-analysis.The PFS and MST for gefitinib?erlotinib and icotinib were 5.48?5.15?5.81 months and 13.26?13.52?12.58 months,respectively.Gefitinib and icotinib had higher PFS than that of erlotinib(P < 0.05).Erlotinib had longer MST than that of gefitinib and icotinib(P < 0.05).Conclusion: Gefitinib?erlotinib and icotinib had similar effect for non-small cell lung cancer patients.Gefitinib had lower frequency of nausea,vomiting and fatigue.Erlotinib could gain longer MST,but it had higher frequency of rash diarrhea nausea and vomiting.Icotinib might have a lower frequency of rash and diarrhea.Thus,we could choose the drug for non-small cell lung cancer according to the patients' physical conditions. |
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