EFFICACY OF TARGETED THERAPY IN UNSELECTED PATIENTS WITH ADVANCED NON-SMALL-CELL LUNG CANCER: A NETWORK META-ANALYSIS

Miaomiao Sheng, Fang Wang, Yueguang Zhao, Shanshan Li, Xiaojie Wang, Tao Shou, Ying Luo, Wenru Tang*

ABSTRACT

Objective: Currently, targeted therapy has shown encouraging treatment benefits in selected patients with advanced non-small cell lung cancer (NSCLC). However, the comparative benefits of targeted drugs and chemotherapy treatments in unselected patients are not clear. We therefore conducted a network meta-analysis to assess the relative efficacy of these regimens. Methods: We searched Pubmed, EMBASE, Cochrane Library and abstracts from major scientific meetings for eligible literatures. The hazard ratio (HR) for progression-free survival (PFS) and overall survival (OS) was used for pooling effect sizes. Bayesian network meta-analysis was conducted to calculate the efficacy of all included treatments. All tests of statistical significance were two sided. Results: A total of 18476 patients from 32 randomized controlled trials (RCT) were assessed. The targeted therapy included bevacizumab (Bev), gefitinib (Gef), erlotinib (Erl) and cetuximab (Cet). Network meta-analysis showed that Bev+chemotherapy (CT) was associated with statistically significant hazard ratio for PFS relative to Gef (HR, 0.73; 95% CI, 0.55-0.96), Erl (HR, 0.64; 95% CI, 0.47-0.83), CT (HR, 0.69; 95% CI, 0.55-0.84) and placebo (HR, 0.49; 95% CI, 0.34-0.67). No statistically significant differences were observed for combination therapy treatments, including Erl+CT, Gef+CT, Bev+CT, Cet+CT and Bev+Erl. Trend analyses of rank probability revealed that Bev+CT and Bev+Erl were among the top ranked for PFS, Cet+CT was most probable to be the rank 1 in terms of OS and followed by Bev+CT. Conclusions: Our study suggested that Bev+CT may offer greater benefits in the treatment of unselected patients with advanced NSCLC. Cet+CT presented the best survival but inferior PFS compared with Bev+CT.

Keywords: non-small-cell lung cancer, targeted drugs, efficacy, network meta-analysis.