• Chee Khoon Lee, Yi-Long Wu, Pei Ni Ding, Sarah J Lord, Akira Inoue, Caicun Zhou, Tetsuya Mitsudomi, Rafael Rosell, Nick Pavlakis, Matthew Links, Val Gebski, Richard J Gralla, and James Chih-Hsin Yang.
• Chee Khoon Lee, Pei Ni Ding, Sarah J. Lord, and Val Gebski, National Health and Medical Research Council Clinical Trials Centre, The University of Sydney; Chee Khoon Lee and Matthew Links, Cancer Care Centre, St George Hospital; Pei Ni Ding, Liverpool Hospital; Sarah J. Lord, School of Medicine, The University of Notre Dame; Nick Pavlakis, Royal North Shore Hospital, Sydney, Australia; Yi-Long Wu, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangdong; Caicun Zhou, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Akira Inoue, Tohoku University Hospital, Sendai; Tetsuya Mitsudomi, Kinki University School of Medicine, Osaka-Sayama, Japan; Rafael Rosell, Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital, Barcelona, Spain; Richard J. Gralla, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY; James Chih-Hsin Yang, Graduate Institute of Oncology, National Taiwan University, and National Taiwan University Hospital, Taipei, Taiwan.
• J. Clin. Oncol. 2015 Jun 10; 33 (17): 1958-65.

PurposeWe examined the impact of different epidermal growth factor receptor (EGFR) mutations and clinical characteristics on progression-free survival (PFS) in patients with advanced EGFR-mutated non-small-cell lung cancer treated with EGFR tyrosine kinase inhibitors (TKIs) as first-line therapy.Patients And MethodsThis meta-analysis included randomized trials comparing EGFR TKIs with chemotherapy. We calculated hazard ratios (HRs) and 95% CIs for PFS for the trial population and prespecified subgroups and calculated pooled estimates of treatment efficacy using the fixed-effects inverse-variance-weighted method. All statistical tests were two sided.ResultsIn seven eligible trials (1,649 patients), EGFR TKIs, compared with chemotherapy, significantly prolonged PFS overall (HR, 0.37; 95% CI, 0.32 to 0.42) and in all subgroups. For tumors with exon 19 deletions, the benefit was 50% greater (HR, 0.24; 95% CI, 0.20 to 0.29) than for tumors with exon 21 L858R substitution (HR, 0.48; 95% CI, 0.39 to 0.58; Pinteraction < .001). Never-smokers had a 36% greater benefit (HR, 0.32; 95% CI, 0.27 to 0.37) than current or former smokers (HR, 0.50; 95% CI, 0.40 to 0.63; Pinteraction < .001). Women had a 27% greater benefit (HR, 0.33; 95% CI, 0.28 to 0.38) than men (HR, 0.45; 95% CI, 0.36 to 0.55; treatment-sex interaction P = .02). Performance status, age, ethnicity, and tumor histology did not significantly predict additional benefit from EGFR TKIs.ConclusionAlthough EGFR TKIs significantly prolonged PFS overall and in all subgroups, compared with chemotherapy, greater benefits were observed in those with exon 19 deletions, never-smokers, and women. These findings should enhance drug development and economic analyses, as well as the design and interpretation of clinical trials.© 2015 by American Society of Clinical Oncology.

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