Chemotherapy may be preferable option in NSCLC with wild type EGFR

Chemotherapy yielded improved PFS vs. treatment using epidermal growth factor receptor tyrosine kinase inhibitors in patients with advanced non–small cell lung cancer with wild-type epidermal growth factor receptor.

However, researchers noted that chemotherapy did not confer a benefit over EGFR TKIs in terms of OS.

In the meta-analysis, researchers conducted a literature search of several scientific databases, including PubMed, Embase, Cochrane database, and abstracts from meetings of the American Society of Clinical Oncology and the European Society of Medical Oncology.

Studies considered eligible included randomized controlled trials of patients with advanced NSCLC in which traditional chemotherapy was compared with EGFR TKI treatment. The researchers identified 11 trials for analysis encompassing 1,605 patients with wild-type EGFR.

The researchers compiled characteristics and outcomes from the trials, and random-effects models were used to pool all measures. The investigators calculated 95% CIs for these data. PFS, represented as HRs, was established as the study’s primary outcome, whereas objective response rate and OS were defined as the secondary outcomes.

The researchers found that in patients with wild-type EGFR tumors, chemotherapy yielded better PFS than TKI (HR for TKI=1.41; 95% CI, 1.1-1.81). The researchers identified no statistically significant differences in terms of first-line vs. second- or later-line treatment, experimental drug, ethnicity, method of EGFR mutation analysis. Studies utilizing more sensitive approaches than direct sequencing were linked to significantly better PFS with chemotherapy (HR for TKI=1.84; 94% CI, 1.35-2.42).

The correlation of chemotherapy and PFS benefit also was significant in second- or later-line trials (HR=1.34; 95% CI, 1.09-1.65). Chemotherapy yielded a higher ORR of 16.8% vs. 7.2% for TKI (RR for TKI=1.11; 95% CI, 1.02-1.21); however, no statistically significant difference was seen regarding improvement in OS (HR for TKI=1.08; 95% CI, 0.96-1.22).

According to the researchers, these findings suggest utility for conventional chemotherapy in patients with wild-type EGFR tumors, but further studies will be needed to fully explore its potential role in this population.

“This study suggests that, in patients with wild-type EGFR tumors, conventional chemotherapy could be a preferable treatment option over EGFR TKI, although this recommendation cannot be conclusive because the overall comparisons were not based on randomization,” the researchers wrote. “Furthermore, the toxicity outcome was not assessed.”

Disclosure: The researchers report no relevant financial disclosures.