Immunotherapy plus Chemotherapy for Patients with EGFR-Mutated Non-Squamous Cell Lung Cancer for Disease Progression after EGFR Tyrosine-Kinase Inhibitor: A Meta-Analysis of Randomized Controlled Trials.

IF 2.5 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2024-09-16 DOI:10.1159/000541415

Ahmed A Refae, Rafat I Abu Shakra, Ezzeldin M Ibrahim

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Abstract

Introduction: Patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations face poor outcomes after progression on tyrosine kinase inhibitors (TKIs). The efficacy of immune checkpoint inhibitors (ICIs) combined with chemotherapy in these patients remains uncertain.

Methods: We searched for studies published between randomized controlled trials of ICIs in combination therapies in advanced NSCLC patients post-EGFR TKI progression. Data on progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were extracted and analyzed.

Results: Six studies with a total of 2,225 patients were analyzed. The pooled hazard ratio (HR) for PFS was 0.60 (95% CI, 0.55-0.65; p < 0.0001), indicating a significant improvement in PFS with ICIs. Subgroup analysis suggested that patients with prior exposure to third-generation TKIs showed a more pronounced benefit (HR = 0.61; 95% CI, 0.49-0.76; p < 0.0001). However, no benefit was found in patients without prior exposure. The efficacy of the experimental interventions was also shown on the pooled estimates of OS (HR = 0.87; 95% CI, 0.77-0.0.99; p value = 0.04) and ORR (OR = 1.91; 95% CI, 1.32-2.76; p < 0.0001).

Conclusion: ICIs may significantly benefit PFS among patients with EGFR-mutated NSCLC who have progressed on TKI treatment. Future research should continue stratifying patients based on prior treatment exposure to optimize therapeutic strategies.

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针对表皮生长因子受体酪氨酸激酶抑制剂治疗后病情进展的表皮生长因子受体突变非鳞状细胞肺癌患者的免疫治疗加化疗：随机对照试验的荟萃分析。

背景：携带表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者在接受酪氨酸激酶抑制剂（TKIs）治疗后病情恶化，治疗效果不佳。免疫检查点抑制剂（ICIs）联合化疗对这些患者的疗效仍不确定：我们搜索了EGFR TKI治疗进展后的晚期NSCLC患者在ICIs联合疗法随机对照试验之间发表的研究。我们提取并分析了无进展生存期（PFS）、总生存期（OS）和客观反应率（ORR）的数据：结果：分析了六项研究，共计2225名患者。汇总的PFS危险比（HR）为0.60（95% CI，0.55 - 0.65；P <0.0001），表明使用ICIs可显著改善PFS。亚组分析表明，曾使用过第三代 TKIs 的患者获益更明显（HR = 0.61; 95% CI, 0.49 - 0.76; P <0.0001）。然而，未曾接受过治疗的患者则没有获益。实验性干预措施的疗效还体现在对 OS（HR = 0.87；95% CI，0.77 - 0.0.99；P 值 = 0.04）和 ORR（OR = 1.91；95% CI，1.32 - 2.76；P <0.0001）的汇总估计值上：ICIs可使TKI治疗进展的EGFR突变NSCLC患者的PFS明显获益。未来的研究应继续根据患者之前的治疗情况对其进行分层，以优化治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.