A meta-analysis of the safety and effectiveness of pemetrexed compared with gefitinib for pre-treated advanced or metastatic NSCLC. Issue 29 (17th July 2020)

• Record Type: Journal Article
• Authors: Lu, Xiaoxin; Li, Shengshu; Chen, Weizong; Zheng, Dongyang; Li, Yuzhu; Li, Fang
• Other Names: Wang. Lu section editor.
• Is Part Of: Medicine. Volume 99:Issue 29(2020)
• Publication Date: 2020-07-17
• Subjects: gefitinib -- meta-analysis -- pemetrexed -- pretreated non-small cell lung cancer patients; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000021170
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Background: The purpose of the current meta-analysis was to compare the oncological outcomes of pemetrexed versus gefitinib in pre-treated advanced or metastatic non-small cell lung cancer (NSCLC) patients. Methods: Search the online electronic databases on comparison the effectiveness and adverse effects of pemetrexed versus gefitinib in therapy outcomes of pre-treated NSCLC to September 2019. All studies analyzed the summary odds ratios (ORs) of the main outcomes, including survival efficacy and toxicity complications. Results: In all, 5 trials involving 676 subjects were included, with 332 receiving pemetrexed and 344 using gefitinib. The pooled analysis of overall survival (OS) (OR = 0.97, 95%CI = 0.77–1.21, P = .76) and progression-free survival (PFS) (OR = 1.17, 95%CI = 0.60–2.30, P = .65) showed that pemetrexed did not achieve benefit when compared with gefitinib. In the results of subgroup analysis among the EGFR mutation-positive patients, the comparison of gefitinib therapy versus pemetrexed did show PFS benefit 0.35 (95%CI 0.12–1.01; P = .05). In terms of grade 3 or 4 side effects, a similar toxicity profile of both pemetrexed and gefitinib was shown in the incidence rate of rash ( P = .045), fatigue ( P = .97), thrombocytopenia ( P = .68) and anemia ( P = .21) between the 2 groups. Conclusion: Pemetrexed was not associated with survival benefit than gefitinib therapy among pre-treated NSCLC patients. While, gefitinib showed superior PFS efficacy than pemetrexed for patients with EGFR mutation-type. Future investigations are required to identify relevant biomarkers in selected patients that would most likely benefit from pemetrexed or gefitinib treatment in pre-treated advanced NSCLC patients.