Conventional chemotherapy may be beneficial in subtypes of non-small cell lung cancer

Image: PD 

1. In this meta-analysis, progression-free survival was longer with conventional chemotherapy compared to epidermal growth factor receptor inhibitor tyrosine kinase inhibitors in individuals with stage IIIB and IV non-small cell lung cancer without epidermal growth factor receptor gene mutations. 

2. In this meta-analysis, overall survival was no different with conventional chemotherapy and epidermal growth factor receptor inhibitor tyrosine kinase inhibitors in individuals with stage IIIB and IV non-small cell lung cancer without epidermal growth factor receptor gene mutations. 

Evidence Rating Level: 1 (Excellent)     

Study Rundown: In patients with non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, tyrosine kinase inhibitors (TKI) are commonly used.  However, in NSCLC patients without EGFR mutations, there remains some controversy as to whether EGFR TKIs or conventional chemotherapies are associated with a better progression-free survival.  This study is a meta-analysis of 11 randomized controlled trials of patients with locally advanced inoperable or metastatic NSCLC without EGFR mutations comparing EGFR TKIs (erlotinib or gefitinib) with conventional chemotherapy.  The progression-free survival was significantly better for conventional chemotherapy than EGFR TKIs.  The overall survival, however, was not statistically different.

Among its strengths, the rigorous inclusion criteria used to select only well designed randomized controlled studies bolsters this meta-analysis.  A weakness of this study, however, is the relatively small number of available studies to analyze and each study’s individual weaknesses. Furthermore, toxicity was not assessed in this analysis. Nonetheless, while further study is necessary, the study supports the current use of conventional chemotherapy in NSCLC patients without EGFR mutations.

Click to read the study, published today in JAMA

Relevant Reading: Role of epidermal growth factor receptor inhibitors in epidermal growth factor receptor wild-type non-small-cell lung cancer

In-Depth [meta-analysis]: This study is a meta-analysis of randomized controlled trials comparing first generation EGFR TKIs (erlotinib or gefitinib) and conventional chemotherapy in individuals with inoperable locally advanced (stage IIIB) or metastatic (stage IV) NSCLC without EGFR mutations.  Eleven trials met the criteria and were included in the meta-analysis.  Ten studies reported progression-free survival.  The progression-free survival was significantly better for conventional chemotherapies than EGFR TKIs (HR 1.41, 95% CI 1.10-1.81, p<0.001).  The objective response rate (proportion of complete or partial responders among all evaluable individuals) was also increased with conventional chemotherapy (RR 1.11, 95% CI 1.02-1.21, p=0.002).  The overall survival, however, was not significantly different between individuals treated with EGFR TKIs and chemotherapy (HR 1.08, 95% CI 0.96-1.22, p=0.496).

More from this author: Risk-reduction counseling with HIV testing may not decrease rates of sexually transmitted infections, Autoantibodies may precede symptom onset in Sjögren’s Syndrome, Peer based health education program linked to reduced waist circumference, No overall change in the prevalence of obesity in the United States between 2003 and 2012, Web-based intervention insufficient for reducing drinking among students 

©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT.