Gefitinib Plus Chemotherapy Versus Cetuximab Plus Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer: A Network Meta-Analysis

Recent randomized control trials have revealed the efficacy and safety of gefitinib plus chemotherapy and cetuximab plus chemotherapy on the treatment of advanced non-small cell lung cancer, but little is known about the differences between them lacking of direct evidences. Randomized control trials were selected by formal search of electronic databases (PubMed, Embase, and Cochrane Library) and trials registers on the Internet. This systematic review and meta-analysis is reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA) Statement and was registered at International Prospective Register of Systematic Reviews. 14 trails were identified finally, with 8 studies about gefitinib plus chemotherapy vs chemotherapy alone and 6 studies about cetuximab plus chemotherapy plus vs chemotherapy alone. For overall survival and progression-free survival, the relative HRs of gefitinib plus chemotherapy vs cetuximab plus chemotherapy were 0.96 (0.81-1.13, p=0.583) and 0.69 (0.45-1.05, p=0.080) on first-line treatment and 1.60 (1.01-2.54, p=0.044) and 0.83 (0.61-1.15, p=0.267) on second-line treatment. For objective response rate and one-year survival rate on first-line treatment, the relative RRs of gefitinib plus chemotherapy vs cetuximab plus chemotherapy were 0.89 (0.69-1.15, p=0.395) and 0.84 (0.72-0.98, p=0.026). For adverse events, the risk of relative RR of leukopenia all grades was 0.73 (0.58-0.91, p=0.006), while other events didn’t exhibit significant differences. Subgroup analysis found that comparing to cetuximab plus chemotherapy, gefitinib plus chemotherapy appeared a better improvement in one-year survival rate of USA advanced NSCLC population [RR=0.83 (0.70-0.99, p=0.042)]. It concluded that, on the treatment of advanced NSCLC patients, the efficacy and safety of gefitinib plus chemotherapy are superior to cetuximab plus chemotherapy on first-line treatment, while the latter may be a better choice as well when it occurs to second-line treatment.