Chemotherapy-Based Combination Regimens for Advanced EGFR-Mutant NSCLC After EGFR-TKI Failure: A Network Meta-Analysis

作者：Lanlan Pang, Weitao Zhuang, Zihong Chen, Jun Liao, Meng-di Li, Li Zhang, Wen‐Feng Fang, Yaxiong Zhang · 发表于：Journal of the National Comprehensive Cancer Network · 年份：2025 · DOI：10.6004/jnccn.2024.7092 · 被引用次数：7 · 研究领域：Lung Cancer Treatments and Mutations、Cancer Immunotherapy and Biomarkers、Radiomics and Machine Learning in Medical Imaging

BACKGROUND: Traditional chemotherapy provides restricted benefits for advanced EGFR-mutant non-small cell lung cancer (NSCLC) after failure of EGFR-tyrosine kinase inhibitors (EGFR-TKIs), necessitating the combined treatment. However, it remains controversial which is the optimal regimen. METHODS: Eligible randomized controlled trials (RCTs) comparing various platinum-based chemotherapy (Chemo) regimens in patients with EGFR-mutated NSCLC who experienced disease progression on EGFR-TKIs were included. A Bayesian random-effects network meta-analysis was performed. Progression-free survival (PFS) was analyzed using the logarithm of hazard ratio (HR) and its standard error, whereas objective response rate (ORR) and treatment-related adverse events (TRAEs) were analyzed using odds ratio (OR) and 95% confidence intervals. RESULTS: A total of 9 RCTs involving 2,534 patients with EGFR-TKI resistance, published between 2022 and 2024, were included in the meta-analysis. The analyzed regimens were summarized into 5 arms: platinum-based doublet chemotherapy ("Chemo"); immunotherapy + chemotherapy ("Chemo_IO"); bevacizumab + chemotherapy ("Chemo_Bev"), immunotherapy combined with bevacizumab (or bispecific antibody against PD-1/PD-L1 and VEGF) + chemotherapy ("Chemo_anti-PD-1/PD-L1_anti-VEGF"), and amivantamab + chemotherapy ("Chemo_Ami"). Compared with "Chemo," both "Chemo_Ami" and "Chemo_anti-PD-1/PD-L1_anti-VEGF" significantly prolonged PFS (HR, 0.48 [95% CI, 0.32-0.71] and HR, 0.51 [...