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Osimertinib Efficacy and Safety in Treating Epidermal Growth Factor Receptor Mutation-Positive Advanced
Mengmeng Zhao1, Jian Zhang1, Jie Gao1
1Department of Thoracic Surgery, Yangzhong People 's Hospital, Zhenjiang City, Jiangsu Province, China.
Abstract:
This study compared the safety and efficacy of osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), with those of other TKIs and its use alongside bevacizumab in patients with EGFR mutation-positive advanced non-small-cell lung cancer. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were used to conduct extensive searches for relevant randomized controlled trials until January 30, 2024. Osimertinib monotherapy favored disease control rate, whereas the comparator treatment arm favored overall survival. Using subgroup analysis, the objective response rate and progression-free survival (PFS) were significantly elevated by Osimertinib monotherapy compared with pemetrexed combined with carboplatin or cisplatin. The comparator treatment arm receiving gefitinib or erlotinib significantly favored progression-free survival and overall survival compared with osimertinib monotherapy. In patients treated with osimertinib monotherapy, the incidence of all adverse events (AEs) decreased compared with comparator treatment arm. Anemia was the only AE associated with osimertinib monotherapy. Pemetrexed combined with carboplatin or cisplatin resulted in greater loss of appetite than osimertinib monotherapy. The most associated AE of osimertinib monotherapy was diarrhea, according to network analysis. Although its efficacy is not consistent with other EGFR TKIs, osimertinib was associated with a decrease in AEs in patients with EGFR mutation-positive advanced non-small-cell lung cancer.
Insights
Osimertinib shows improved safety and disease control in EGFR-positive non-small cell lung cancer. While not always superior in overall survival, it offers a better adverse event profile compared to other treatments.
Area of Science:
- Oncology
- Pharmacology
- Clinical Trials
Background:
- Non-small cell lung cancer (NSCLC) with EGFR mutations presents treatment challenges.
- Third-generation EGFR tyrosine kinase inhibitors (TKIs) like osimertinib offer targeted therapy options.
- Comparative safety and efficacy data for osimertinib are crucial for clinical decision-making.
Purpose of the Study:
- To compare the safety and efficacy of osimertinib versus other TKIs in EGFR mutation-positive advanced NSCLC.
- To evaluate osimertinib's efficacy and safety when used with bevacizumab.
- To analyze adverse event profiles across different treatment regimens.
Main Methods:
- Systematic literature search of randomized controlled trials (RCTs) across multiple databases until January 30, 2024.
- Inclusion of studies comparing osimertinib (monotherapy or combination) with other TKIs or standard chemotherapy.
- Network meta-analysis to assess efficacy outcomes (objective response rate, progression-free survival, overall survival) and safety (adverse events).
Main Results:
- Osimertinib monotherapy demonstrated a higher disease control rate but was associated with lower overall survival compared to some comparator arms.
- Osimertinib monotherapy significantly improved objective response rate and progression-free survival versus pemetrexed-based chemotherapy.
- Compared to gefitinib or erlotinib, osimertinib monotherapy showed less favorable progression-free survival and overall survival but a reduced incidence of overall adverse events.
Conclusions:
- Osimertinib offers a favorable safety profile with decreased adverse events in EGFR-positive advanced NSCLC patients.
- While efficacy varies, particularly in overall survival compared to some TKIs, osimertinib demonstrates significant benefits in objective response rate and progression-free survival against certain chemotherapies.
- Diarrhea was the most frequently associated adverse event with osimertinib monotherapy.
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