Impact of EGFR Inhibitor in Non–Small Cell Lung Cancer on Progression-Free and Overall Survival: A Meta-Analysis

TLDR: EGFR mutation is a predictive biomarker of PFS benefit with EGFR-TKIs treatment in all settings and should be considered as front-line therapy in EGFRmut(+) advanced NSCLC patients, supporting EGFR mutation assessment before initiation of treatment.

Abstract: known in 31% of patients. EGFR-TKIs treatment prolonged PFS in EGFRmut+ patients, and EGFR mutation was predictive of PFS in all settings: The front-line hazard ratio for EGFRmut+ was 0.43 (95% confidence interval [CI] = 0.38 to 0.49; P < .001), and the front-line hazard ratio for EGFRmut– was 1.06 (95% CI = 0.94 to 1.19; P = .35; Pinteraction < .001). The second-line hazard ratio for EGFRmut+ was 0.34 (95% CI = 0.20 to 0.60; P < .001), and the second-line hazard ratio for EGFRmut– was 1.23 (95% CI = 1.05 to 1.46; P = .01; Pinteraction < .001). The maintenance hazard ratio for EGFRmut+ was 0.15 (95% CI = 0.08 to 0.27; P < .001), and the maintenance hazard ratio for EGFRmut– was 0.81 (95% CI = 0.68 to 0.97; P = .02; Pinteraction < .001). EGFR-TKIs treatment had no impact on OS for EGFRmut+ and EGFRmut– patients. Conclusions EGFR-TKIs therapy statistically significantly delays disease progression in EGFRmut+ patients but has no demonstrable impact on OS. EGFR mutation is a predictive biomarker of PFS benefit with EGFR-TKIs treatment in all settings. These findings support EGFR mutation assessment before initiation of treatment. EGFR-TKIs should be considered as front-line therapy in EGFRmut+ advanced NSCLC patients. J Natl Cancer Inst;2013;105:595–605