A meta-analysis for the efficacy and safety of icotinib combined with radiotherapy in treating brain metastases of non-small cell lung cancer

Abstract

Background: Currently, the therapies for brain metastases of non-small cell lung cancer (NSCLC) mainly include whole brain radiotherapy and icotinib. For exploring the efficacy and safety of radiotherapy and icotinib, a meta-analysis was performed based on a series of data. Method: A systematic search was performed on PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure and Wanfang Database. The search time was set from the database establishment to December, 2022. All randomized controlled trials evaluating the efficacy and safety of whole brain radiotherapy alone or in combination with icotinib for whole brain metastases of NSCLC were included in our meta-analysis. Clinical outcomes and adverse reactions were analyzed using Stata17.0 software. Results: Finally, 10 clinical studies were enrolled in this meta-analysis, including 717 patients. Briefly, compared with radiotherapy alone, icotinib combined with radiotherapy increased response rate [relative ratio (RR) = 1.240; 95% confidence interval (CI) (1.141, 1.348); P < .001] and disease control rate (RR = 1.240, 95% CI [1.141,1.348], P < .001). Besides, according to the outcomes of adverse reaction assessment exhibited, there were no significant differences between the 2 group patients in the incidence of rash (RR = 1.536, 95% CI [0.694, 3.402], P = .290), adverse reaction in gastrointestinal tract (RR = 1.060, 95% CI [0.792, 1.419], P = 1.419), hepatic injury (RR = 1.541, 95% CI [0.798,2.975], P = .198) and leukopenia (RR = 1.182, 95% CI [0.787, 1.777], P = .421). However, the patients receiving combination treatment showed much longer progression free survival than those receiving radiotherapy alone (standardized mean difference = 1.559; 95% CI [0.699, 2.419]; P < .001). Conclusion: Icotinib combined with radiotherapy can significantly short-term and long-term efficacy of NSCLC patients with brain metastases but not increase adverse reactions.

Efficacy and safety of EGFR-TKI combined with WBRT vs. WBRT alone in the treatment of brain metastases from NSCLC: a systematic review and meta-analysis

“…Two papers (31,34) used it for 8 weeks, one (33) for 4 weeks, one (36) for 12 weeks, and one (26) did not specify the duration. Nine other papers (18,19,21,23,28,32,35,37,38) used 125 mg of erlotinib orally, except for one (19), of which four (18,19,21,38) were administered until disease progression or intolerable toxicity, two (23,37) were administered for 4 weeks, two (32,35) were administered for 2 weeks, and one (28) was not elucidated for duration of administration; four papers (20,24,27,29) used oral 125 mg icotinib, of which two papers (27,29) used it until disease progression or intolerable toxicity, one paper (20) used it for 4 weeks, and one paper (24) did not elaborate on the duration of continued use. One paper (30) used oral 80 mg osimertinib until disease progression or intolerable toxicity.…”

“…One paper (30) used oral 80 mg osimertinib until disease progression or intolerable toxicity. Seven studies (20,21,25,31,34,38,40) included patients with EGFR mutations, and 14 studies (19, 22-24, 26-28, 30, 32, 33, 35-37, 39) omitted the description of the EGFR status among patients. One article (18) reported EGFR rates, where the experimental and control groups displayed rates of 54.7 and 44.7%, respectively.…”

“…Another article (29) noted EGFR rates with the experimental and control groups at 56.5 and 42.9%, respectively. The quality of the included literature was evaluated by the Cochrane ROB tool, where 12 studies (18,20,21,23,30,(32)(33)(34)(35)(36)(37)40) were classified as unclear, and six studies (22, 26-28, 31, 39) posed a high risk. Meanwhile, five articles (19,24,25,29,38) were deemed low risk.…”

“…Twenty articles (20)(21)(22)(23)(24)(25)(26)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) presented data on the iDCR. Employing a random-effects model for amalgamating the statistics, the analysis revealed negligible heterogeneity (I 2 = 0.0%, p = 0.488).…”