Quotation Tan, Pui San, Bilger, Marcel, de Lima Lopes, Gilberto, Acharyya, Sanchalika, Haaland, Benjamin. 2017. Meta-analysis of first-line therapies with maintenance regimens for advanced non-small-cell lung cancer (NSCLC) in molecularly and clinically selected populations. Cancer Medicine. 6 (8), 1847-1860.


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Abstract

Evidence has suggested survival benefits of maintenance for advanced NSCLC patients not progressing after first‐line chemotherapy. Additionally, particular first‐line targeted therapies have shown survival improvements in selected populations. Optimal first‐line and maintenance therapies remain unclear. Here, currently available evidence was synthesized to elucidate optimal first‐line and maintenance therapy within patient groups. Literature was searched for randomized trials evaluating first‐line and maintenance regimens in advanced NSCLC patients. Bayesian network meta‐analysis was performed within molecularly and clinically selected groups. The primary outcome was combined clinically meaningful OS and PFS benefits. A total of 87 records on 56 trials evaluating first‐line treatments with maintenance were included. Results showed combined clinically meaningful OS and PFS benefits with particular first‐line with maintenance treatments, (1) first‐line intercalated chemotherapy+erlotinib, maintenance erlotinib in patients with EGFR mutations, (2) first‐line afatinib, maintenance afatinib in patients with EGFR deletion 19, (3) first‐line chemotherapy + bevacizumab, maintenance bevacizumab in EGFR wild‐type patients, (4) chemotherapy+conatumumab, maintenance conatumumab in patients with squamous histology, (5) chemotherapy+cetuximab, maintenance cetuximab or chemotherapy + necitumumab, maintenance necitumumab in EGFR FISH‐positive patients with squamous histology, and (6) first‐line chemotherapy+bevacizumab, maintenance bevacizumab or first‐line sequential chemotherapy+gefitinib, maintenance gefitinib in patients clinically enriched for EGFR mutations with nonsquamous histology. No treatment showed combined clinically meaningful OS and PFS benefits in patients with EGFR L858R or nonsquamous histology. Particular first‐line with maintenance treatments show meaningful OS and PFS benefits in patients selected by EGFR mutation or histology.

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Publication's profile

Status of publication Published
Affiliation External
Type of publication Journal article
Journal Cancer Medicine
Citation Index SCI
Language English
Title Meta-analysis of first-line therapies with maintenance regimens for advanced non-small-cell lung cancer (NSCLC) in molecularly and clinically selected populations
Volume 6
Number 8
Year 2017
Page from 1847
Page to 1860
Reviewed? Y
DOI http://dx.doi.org/10.1002/cam4.1101
Open Access Y
Open Access Link https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.1101

Associations

People
Bilger, Marcel (Details)
External
Acharyya, Sanchalika (Duke-NUS Medical School, Singapore)
de Lima Lopes, Gilberto (University of Miami Health System, United States/USA)
Haaland, Benjamin (University of Utah, United States/USA)
Tan, Pui San (University of Oxford, United Kingdom)
Organization
Health Economics and Policy Group AB (Details)
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