Z. Yuan, D. Tao, W. Zhou, and Y. Z. Wu; Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
Purpose/Objective(s): The role of stereotactic body radiotherapy (SBRT) on the advanced EGFR-mutant non-small cell lung cancer (NSCLC) treated by first-line EGFR-TKIs was still unclear. This study aimed to explore the efficacy and safety of SBRT plus first-line EGFR-TKIs in advanced EGFR-mutant NSCLC by conducting a meta-analysis. Materials/
Methods: PubMed, Embase and The Cochrane Library were searched from inception through 31 December 2023. Any clinical trials evaluating the efficacy and safety of SBRT plus first-line EGFR-TKIs in advanced NSCLC were included. Two researchers independently conducted the literature screening and data extraction. The extracted information included study designs, sample sizes, patient characteristics, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. A traditional meta-analysis was performed using Review Manager software. Results: Five trials involving 467 eligible patients diagnosed with EGFR-mutated NSCLC were included after screening. The SBRT plus EGFR-TKIs group showed a significantly longer PFS compared to the EGFR-TKIs alone group (HR = 0.39, 95% CI: 0.24-0.64, P < 0.001). No significant difference in OS was observed between the two groups (HR = 0.78, 95% CI: 0.39-1.58, P = 0.5). However, in the subset analysis of two prospective randomized controlled trials, patients who received EGFR-TKIs plus SBRT had a significantly favorable OS compared to patients who received EGFR-TKIs alone (HR = 0.47, 95% CI: 0.33-0.69, P < 0.001). For safety analysis, no significant difference in the incidence of grade = 3 adverse events (AEs) between the two groups (P = 0.78). In the analysis of AEs of all grades, the SBRT plus EGFR-TKIs group had a higher probability of developing pneumonitis (P = 0.003) and radiation dermatitis (P = 0.002) compared to the EGFR-TKIs alone group. Conclusion: Our meta-analysis demonstrated that the SBRT plus first-line EGFR-TKIs significantly prolonged the PFS with tolerable toxicity in patients with advanced EGFR-mutant NSCLC. The findings of this study suggest that SBRT plus first-line EGFR-TKIs might be a promising treatment strategy for patients with advanced NSCLC.
