M-01: Efficacy and Safety of Tyrosine-Kinase Inhibitors as First-Line Treatment in Advanced NSCLC Patients: A Network Meta-Analysis

Poster Presenter

Ismaeel Yunusa

Graduate Student
Massachusetts College of Pharmacy and Health Sciences
United States

Objectives

To compare the efficacy and safety of EGFR-TKI’s as first-line treatment in patients with locally advanced, metastatic NSCLC with positive EGFR mutation.

Method

We searched the following databases; PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for relevant articles up to December 2018. We selected RCTs comparing at least 2 TKIs or a TKI with PBCT. We performed a frequentist random-effects NMA using the multivariate meta-analysis approach.

Results

Fifteen eligible trials (3750 patients) were included. There were statistically significant differences between some TKIs and PBCT for overall survival (OS), progression-free survival (PFS) and grade 3 or higher adverse events. PFS results suggests that dacomitinib had highest probability of being the most effective (SUCRA, 75.9%), followed by, osimertinib (SUCRA, 69.5%), erlotinib (SUCRA, 59.9%), afatinib (SUCRA, 55.9%), gefitinib (SUCRA, 36.1%), PBCT (SUCRA, 2.7%). We observed a similar ranking trend for OS except for the fact that dacomitinib and osimertinib has no OS data. Adverse events results suggest that osimertinib (SUCRA, 84.3%) and gefitinib (SUCRA, 78.9%) has the highest probability of being the safest. Upon simultaneously visualizing efficacy and safety in cluster plots, osimertinib, gefitinib, and erlotinib formed a cluster for the most effective and safe TKIs while dacomitinib and afatinib formed a cluster for lesser safety and effective TKIs.

Conclusion

This NMA suggests that osimertinib, gefitinib, and erlotinib might be the most efficacious and safest TKIs.