The Efficacy Of First-Generation EGFR-TKIs And Second-Generation EGFR-TKIs In The Treatment Of Advanced Non-Small Cell Lung Cancer:A Meta-Analysis

Object:To evaluate the effectiveness and safety of first-generation EGFR-TKIs and second-generation EGFR-TKIs in the treatment of advanced non-small cell lung cancer.Method:PubMed,The Cochrane library,Web of Science,Embase,CBM,CNKI,WanFang Data and VIP databases were electronically searched to collect randomized controlled trials(RCTs)of first-generation EGFR-TKIs and second-generation EGFRTKIs for the treatment of advanced non-small cell lung cancer from inception to June 11,2018.The search time ranged from inception to June 10,2018.After two independent researchers screened the literature,extracted the data,and evaluated the risk of bias in the included studies,statistical analysis was performed using Stata14.0 to calculate the odds ratio(OR)and its 95% confidence interval(CI).The study endpoint was median progression-free survival(mPFS),median overall survival(mOS),objective response rate(ORR),disease control rate(DCR)and security.Results:A total of 6 articles were included,including 5 RCTs,2 of which were different outcomes of the same randomized controlled trial,totaling 2632 patients.Meta-analysis showed that second-generation EGFR-TKIs treatment could improve the objective response rate of patients with advanced non-small cell lung cancer compared with the first generation of EGFR-TKIs [OR=1.58],95%CI=(1.25,1.99),P=0.000],disease control rate [OR=1.36,95%CI=(1.03,1.80),P=0.033],median progression-free survival [HR=0.75,95%CI=(0.63,0.90),P=0.002].However,there was no significant difference in overall survival between the two groups [HR=0.87,95% CI=(0.76,1.01),P=0.07].In terms of ? grade 3 adverse reactions,second-generation EGFR-TKIs therapy had higher rates of diarrhea [OR = 5.16,95 %CI =(3.40,7.85),P = 0.000),stomatitis [OR = 9.85,95% CI =(3.91,24.80),P = 0.000),paronychia [OR = 3.40,95% CI =(1.61,7.20),P=0.001],Hypokalemia [OR=3.30,95% CI=(1.13,9.62),P=0.029),etc.There were no significant differences between two groups in rash or acne,dry skin,pruritus,fatigue,alopecia,nausea,vomiting,conjunctivitis,hand-foot syndrome,weight loss,dehydration,dermatitis,acneiform.Conclusion:Second-generation EGFR-TKIs in patients with advanced non-small cell lung cancer can improve the objective response rate,disease control rate and median progression-free survival.However,this program may lead to an increased incidence of adverse reactions such as diarrhea,stomatitis,paronychia,and hypokalemia.