First-Line Integration of Local Ablative Therapy With EGFR Tyrosine Kinase Inhibitors in Advanced EGFR+ NSCLC: A Systematic Review and Meta-Analysis

作者：Leonardo Brunetti, Giacomo Colella, Giuseppina Rita Di Fazio, Giulia La Cava, Valentina Santo, Federica Pecci, Jiulia Rotow, Jessica R. Bauman, Amin H. Nassar, Elio Adib, Abdul Rafeh Naqash, Marco Tagliamento, Roberto Ferrara, Fabrizio Citarella, Marco Russano, Biagio Ricciuti, Corinne Faivre-Finn, Lizza E.L. Hendriks, Antonio Passaro, Bruno Vincenzi, Fabian Acker, Lisa Derosa, David Planchard, Hugo J.W.L. Aerts, Silvia Novello, Francesco Passiglia, Carlo Greco, Sara Ramella, Alessio Cortellini · 发表于：Journal of Thoracic Oncology · 年份：2026 · DOI：10.1016/j.jtho.2026.103735 · 被引用次数：1 · 研究领域：Lung Cancer Treatments and Mutations、HER2/EGFR in Cancer Research、Chronic Myeloid Leukemia Treatments

INTRODUCTION: Systemic intensification strategies improve outcomes in advanced EGFR-mutated NSCLC but increase toxicity. Integrating local ablative therapy (LAT) with first-line EGFR tyrosine kinase inhibitor (TKI) monotherapy represents an alternative approach to enhance disease control while preserving long-term tolerability. METHODS: MEDLINE, Embase, and Elicit were searched to December 2025. The protocol was registered in PROSPERO (CRD420251244650). Randomized and nonrandomized comparative studies evaluating EGFR TKI with or without LAT integrated into first-line treatment, either upfront or as consolidative therapy, were included in quantitative meta-analyses. Single-arm and noncomparative studies were analyzed descriptively. Hazard ratios (HRs) were pooled using random-effects models. Prespecified subgroup analyses explored disease burden, LAT timing, study design (prospective versus retrospective), LAT site, and TKI generation. RESULTS: A total of 31 studies met the inclusion criteria, including 24 comparative studies (six randomized, two prospective nonrandomized, and 16 retrospective). LAT integration significantly improved progression-free survival (HR = 0.45, 95% confidence interval: 0.37-0.55) and overall survival (HR = 0.52, 95% confidence interval: 0.40-0.67) versus EGFR TKI alone. Benefits were consistent across oligometastatic and unselected populations, upfront and consolidative strategies, LAT sites (primary tumor with or without metastatic sites), TKI gener...