Maria Wisnu Donowati, Erna Kristin, Susanna Hilda Hutajulu, Dwi Endarti, Ricvan Dana Nindrea
Nonsmall cell lung cancer is the most common carcinoma in Asia with more than half identified as epidermal growth factor receptor mutation-positive (EGFRm+). First- and second-generation EGFR tyrosine kinase inhibitors (TKIs), a targeted therapy type, improved overall survival compared to platinum-based chemotherapy. We conducted an updated review comparing the clinical effectiveness of EGFR TKIs as a first-line treatment in Asian populations with EGFRm+. This systematic search was conducted in six databases, resulting in 30 eligible articles, which represented Asian ethnicity and were appraised quantitatively using the GRACE checklist. Thirteen eligible studies and 3, 465 patients were included in the meta-analysis. Two models of effectiveness comparison were used to measure the pooled size effect: afatinib and dacomitinib. Afatinib in patients with brain metastases had a higher risk of progression and death, but lower time to treatment failure (TTF). Never-smoking patients had lower risk of TTF and death, but equivalent risk for progression. Dacomitinib had a lower risk of progression and death. Exon 19 deletion (e19del) or exon 21 substitution (L858R) benefited more from the second generation. L858R had a higher risk of survival, progression-free, and overall survival than e19del with second-generation agents. Coexisting e19del or L858R in uncommon mutation is associated with longer progression than without it. © 2024 Maria Wisnu Donowati et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Doctoral Program of Faculty Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito General Hospital, Yogyakarta, Indonesia; Department of Pharmaceutic, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia; Department of Biostatistic and Epidemiology, Faculty of Medicine, Universitas Negeri Padang, Bukittinggi, Indonesia; Faculty of Pharmacy, Sanata Dharma University, Yogyakarta, Indonesia
