Which TKIs are safe, effective for EGFR-mutated NSCLC?

First-line treatment with erlotinib, gefitinib, and osimertinib demonstrates safety and efficacy in patients with EGFR-mutated advanced nonsmall cell lung cancer (NSCLC), suggests a study.

A team of investigators performed a systematic electronic search on the databases of Scopus, PubMed, and Web of Science from inception to May 2024. They looked for trials that reported the safety and efficacy of osimertinib, erlotinib, or gefitinib in the treatment of EGFR-mutated advanced NSCLC. No data or language restriction was applied.

Objective response rate (ORR) and disease control rate (DCR) were evaluated. Finally, the risk of bias was determined using the RoB 2 tool, with R programming language doing all the statistical synthesis.

Nineteen trials met the eligibility criteria for the meta-analysis. All three EGFR-tyrosine kinase inhibitors (TKIs) were safe and effective for NSCLC. Osimertinib exhibited the highest ORR (72 percent, 95 percent confidence interval [CI], 65–78) when compared with erlotinib (69 percent, 95 percent CI, 58–79) and gefitinib (64 percent, 95 percent CI, 64–78).

Overall, all study drugs improved ORR (68 percent, 95 percent CI, 63–73).

Likewise, osimertinib showed the highest effect in disease control among patients with NSCLC (94 percent, 95 percent CI, 91–97) relative to gefitinib (68 percent, 95 percent CI, 41–89). Overall, these two EGFR-TKIs effectively controlled the disease (82 percent, 95 percent CI, 67–93).

“The meta-analysis outcomes have demonstrated that osimertinib, erlotinib, or gefitinib positively impact overall response rate and disease control,” the investigators said.