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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Targeted drugs for unselected patients with advanced non-small-cell lung cancer: a network meta-analysis
Miaomiao Sheng1, Yueguang Zhao1, Fang Wang1
11 Laboratory of Molecular Genetics of Aging & Tumor, Medical Faculty, Kunming University of Science and Technology, Kunming 650500, China ; 2 First People's Hospital of Yunnan Province, Kunming 650032, China.
Background:
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 (CT) treatments in unselected patients are not clear. We therefore conduct a network meta-analysis to assess the relative efficacy and safety of these regimens.
Methods:
PubMed, EMBASE, Cochrane Library and abstracts from major scientific meetings were searched for eligible literatures. The odds ratio (OR) for objective response rate (ORR) and safety was used for pooling effect sizes. Bayesian network meta-analysis was conducted to calculate the efficacy and safety of all included treatments. All tests of statistical significance were two sided.
Results:
A total of 13,060 patients from 24 randomized controlled trials (RCT) were assessed. The targeted agents included bevacizumab (Bev), gefitinib (Gef), erlotinib (Erl) and cetuximab (Cet). Network meta-analysis showed that Bev + CT had a statistically significantly higher incidence of ORR relative to the other six different treatments, including placebo (OR =6.47; 95% CI, 3.85-10.29), Erl (OR =2.81; 95% CI, 2.08-3.70), CT (OR =1.92; 95% CI, 1.61-2.28), Gef (OR =1.40; 95% CI, 1.10-1.75), Erl + CT (OR =1.46; 95% CI, 1.17-1.80) and Gef + CT (OR =1.75; 95% CI, 1.36-2.22), whereas placebo and Erl were associated with statistically significantly lower incidence of ORR. Trend analyses of rank probability revealed that Bev + CT had the highest probability of being the best treatment arm in term of ORR, followed by Cet + CT. Meanwhile, Cet + CT showed significant severer rash and thrombocytopenia compared with Bev + CT. Gef was probable to be the rank 3 for ORR but was associated with relatively low risk for grade ≥3 toxicities.
Conclusions:
Our study suggested that Bev + CT may offer better ORR in the treatment of unselected patients with advanced NSCLC. Future studies will be needed to investigate whether the increase of ORR with targeted drugs would be translated into survival benefits.
Insights
Bevacizumab plus chemotherapy may improve objective response rates in advanced non-small cell lung cancer (NSCLC) patients. Further research is needed to confirm if this improves survival benefits.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Targeted therapy shows promise in specific advanced non-small cell lung cancer (NSCLC) cases.
- Comparative efficacy of targeted drugs versus chemotherapy in unselected NSCLC patients remains unclear.
Purpose of the Study:
- To conduct a network meta-analysis assessing the relative efficacy and safety of targeted drugs and chemotherapy regimens in advanced NSCLC.
- To compare objective response rates (ORR) and safety profiles of various treatment options.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Cochrane Library, and major scientific meeting abstracts.
- Bayesian network meta-analysis using odds ratios (OR) for objective response rate (ORR) and safety outcomes.
- Inclusion of 24 randomized controlled trials (RCTs) involving 13,060 patients.
Main Results:
- Bevacizumab plus chemotherapy (Bev + CT) demonstrated a significantly higher ORR compared to placebo, erlotinib (Erl), chemotherapy (CT), gefitinib (Gef), Erl + CT, and Gef + CT.
- Bev + CT showed the highest probability of being the best treatment for ORR, followed by cetuximab plus chemotherapy (Cet + CT).
- Cet + CT was associated with more severe rash and thrombocytopenia than Bev + CT; Gef showed moderate ORR with low toxicity.
Conclusions:
- Bevacizumab plus chemotherapy may enhance ORR in unselected advanced NSCLC patients.
- Further investigation is required to determine if the observed increase in ORR translates to improved survival benefits.
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