Indirect comparison of the efficacy and safety of gefitinib and cetuximab-based therapy in patients with advanced non-small-cell lung cancer

Abstract

The aim of this study was to systematically evaluate the efficacy and safety of gefitinib and cetuximab-based therapies in patients with advanced non-small-cell lung cancer (NSCLC). The studies to be used for the comparisons were selected from the available literature on gefitinib and cetuximab-based therapies compared to conventional chemotherapy in patients with advanced NSCLC. The meta-analysis was performed with RevMan 5.0 software and the Bucher approach was applied to conduct the indirect comparisons. A total of 4 studies, including 935 patients, on gefitinib therapy vs. conventional chemotherapy and 4 studies, including 1,015 patients, on cetuximab-based therapy vs. conventional chemotherapy, were used for indirect comparisons. As regards efficacy, the risk ratio (RR) of objective response rate and 1-year survival rate between gefitinib and cetuximab-based therapies in patients with advanced NSCLC were 0.99 [95% confidence interval (CI): 0.75-1.32; P=0.9584] and 0.85 (95% CI: 0.71-1.01; P=0.0696), respectively, and the mean difference of progression-free survival and overall survival (OS) were -0.15 (95% CI: -0.90 to 0.60; P=0.6946) and -1.84 (95% CI: -3.53 to -0.15; P=0.0331), respectively. As regards safety, the RR of grade 3/4 adverse events (AEs) was 0.29 (95% CI: 0.19-0.44; P=0.0001). The results demonstrated that cetuximab-based therapy was superior to gefitinib therapy in terms of OS and inferior to gefitinib therapy in terms of AEs, whereas there were no significant differences in terms of efficacy and safety between the two therapies on other endpoints adopted for advanced NSCLC. However, further well-designed randomized controlled trials and continuous studies are required to confirm our findings.

Indirect treatment comparison of dabrafenib plus trametinib versus vemurafenib plus cobimetinib in previously untreated metastatic melanoma patients

“…However, it should be noted that health technology agencies such as the French Haute Autorité de Santé and the Agency for Healthcare Research and Quality recommend the use of Bucher's ITC method for both efficacy and safety outcomes. Additionally, one study has been published using this method when indirectly comparing safety outcomes [31]. AE adverse event, ALP alkaline phosphatase, ALT alanine aminotransferase, AST aspartate aminotransferase, CI confidence interval, CPK creatine phosphokinase, GGT gamma-glutamyltransferase, LCI lower 95% CI, RR risk ratio, SCC squamous cell carcinoma, UCI upper 95% CI Consideration should also be given to the fact that while the ITC indicates a better safety profile of dabrafenib plus trametinib in terms of the frequency of adverse events, this may not translate into a real-world patient experience, where, for example, certain grade 2 adverse events may have a greater impact on a patient's quality life than a grade 3-elevated AST/ALT.…”