Efficacy and Safety of Radiotherapy Plus EGFR-TKIs in NSCLC Patients with Brain Metastases: A Meta-Analysis of Published Data.

ABSTRACT:

Background

The role of radiotherapy (RT) combined with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in non-small cell lung cancer (NSCLC) patients with brain metastasis (BM) remains controversial. Therefore, we conducted a meta-analysis to comprehensively evaluate the efficacy and safety of RT plus EGFR-TKIs in those patients.

Materials and methods

Relevant literatures published between 2012 and 2017 were searched. Objective response rate(ORR), disease control rate (DCR), overall survival (OS), intracranial progression-free survival (I-PFS) and adverse events (AEs) were extracted. The combined hazard ratios (HRs) and relative risks (RRs) were calculated using random effects models.

Results

Twenty-four studies (2810 patients) were included in the analysis. Overall, RT plus EGFR-TKIs had higher ORR (RR?=?1.32, 95%CI: 1.13-1.55), DCR (RR?=?1.12, 95%CI: 1.04-1.22), and longer OS (HR?=?0.72, 95%CI: 0.59-0.89), I-PFS (HR?=?0.64, 95%CI: 0.50-0.82) than monotherapy, although with higher overall AEs (20.2% vs 11.8%, RR?=?1.34, 95% CI: 1.11-1.62). Furthermore, subgroup analyses found concurrent RT plus EGFR-TKIs could prolong OS (HR?=?0.69, 95%CI: 0.55-0.86) and I-PFS (HR?=?0.57, 95%CI: 0.44-0.75). Asian ethnicity and lung adenocarcinoma (LAC) patients predicted a more favorable prognosis (HR?=?0.69,95%CI: 0.54-0.88, HR?=?0.66, 95%CI: 0.53-0.83, respectively).

Conclusion

RT plus EGFR-TKIs had higher response rate, longer OS and I-PFS than monotherapy in NSCLC patients with BM. Asian LAC patients with EGFR mutation had a better prognosis with concurrent treatment. The AEs of RT plus EGFR-TKIs were tolerated.

SUBMITTER: Wang X 

PROVIDER: S-EPMC6074003 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature