Necitumumab plus platinum-based chemotherapy versus chemotherapy alone as first-line treatment for stage IV non-small cell lung cancer: a meta-analysis based on randomized controlled trials

Abstract

Background: Whether necitumumab combined with platinum-based chemotherapy (NC) for treating stage IV non-small cell lung cancer (NSCLC) as a first-line treatment could enhance antitumor effectiveness compared with platinum-based chemotherapy alone (CA) treatment is still controversial. The antitumor effectiveness and toxicity of the two treatments were compared in this meta-analysis.Methods: We searched in PubMed, ScienceDirect, Scopus, Web of Science, Ovid MEDLINE, the Cochrane Library, Embase, and Google Scholar to acquire applicable articles. The outcome indicators mainly included progression-free survival (PFS), overall survival (OS) and adverse effects (AEs).Results: Eight articles based on 4 randomized controlled trials were obtained. The NC group had a longer PFS [95% confidence interval (CI): 0.84-0.99, P=0.03] and a higher disease control rate (DCR, 95% CI: 1.01-1.10, P=0.03) than those of the CA group. OS (95% CI: 0.85-1.01, P=0.09) and the objective response rate (ORR, 95% CI: 0.93-1.71, P=0.14) were similar in the NC and CA groups. Nevertheless, in both quantity and extent, the NC treatment had more severe skin rash, hypomagnesemia, and venous thromboembolism than those of the CA treatment. Subanalysis suggested that the advantage of OS was more obvious in the NC group than that in the CA group in patients with high epidermal growth factor receptor (EGFR) expression.Conclusions: With a longer PFS and a higher DCR, NC treatment seemed to be more suitable for treating stage IV NSCLC as first-line therapy, especially for those with high EGFR expression, but its AEs could not be ignored.

The diverse landscape of dermatologic toxicities of non‐immune checkpoint inhibitor monoclonal antibody‐based cancer therapy

“…EGFR is highly expressed in keratinocytes within the epidermis and at the hair follicle roots, and these toxicities arise from alteration of EGFR signaling, leading to abnormalities in growth and migration as well as release of inflammatory cytokines and sensitization to ultraviolet radiation 225 . As with EGFR Nibs, acneiform dermatitis is the most prevalent side effect of anti‐EGFR mAbs 15,16,46,226 . Histopathologically, these lesions are similar to those seen with use of mitogen‐activated protein kinase kinase (MAPKK or MEK) inhibitors and present as superficial (Figure 1) or suppurative perifolliculitis with neutrophilic infiltrates, rupture of the epithelial lining, and follicular hyperkeratosis 45,227 …”

“…225 As with EGFR Nibs, acneiform dermatitis is the most prevalent side effect of anti-EGFR mAbs. 15,16,46,226 Histopathologically, these lesions are similar to those seen with use of mitogen-activated protein kinase kinase (MAPKK or MEK) inhibitors and present as superficial (Figure 1) or suppurative perifolliculitis with neutrophilic infiltrates, rupture of the epithelial lining, and follicular hyperkeratosis. 45,227 Severe reactions to treatment with mAbs against EGFR include Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), including one fatal case.…”

Hypomagnesemia is a Risk Factor for Venous Thromboembolism (VTE) in Acutely Ill, Hospitalized Elderly Patients. A Retrospective Cohort Analysis of 6,428 Patients.

“…Nevertheless, a direct association between hypomagnesemia and increased incidence of VTE was not previously published. In their publication (22), Wang et al described a combination of hypomagnesemia and increased incidence of VTE but without a causative relation. They described both, as consequences of platinum-based chemotherapy.…”

Best regimens for treating chemo‐naïve incurable squamous non‐small cell lung cancer with a programmed death‐ligand 1 tumor proportion score of 1%–49%: A network meta‐analysis

“…Adverse events such as skin rash, venous thromboembolism, and eye disorders should be noted. 28 For squamous lung cancer with PD-L1 TPS of 1%-49%, platinum + Atz is recommended by the guidelines of the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the European Society for Medical Oncology. However, the results of Impower 130, 29 which compared platinum + Ptx + bevacizumab + Atz and platinum + Ptx + bevacizumab against squamous cancer, did not show any effect on OS.…”

“…Nctm is a monoclonal antibody against EGFR and has been reported to be effective in patients with high EGFR or squamous cancer scores. Adverse events such as skin rash, venous thromboembolism, and eye disorders should be noted 28 …”