How does combination therapy fare as second-line treatment for NSCLC with EGFR mutation?

Combination therapy does not appear to have beneficial effects in terms of progression-free survival (PFS), overall response rate (ORR), disease control rate (DCR), and incidence of adverse events compared with monotherapy in patients with advanced nonsmall cell lung cancer (NSCLC) who failed first-line treatment with an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor, a study has shown.

Eligible randomized controlled trials were identified using the databases of PubMed, Web of Science, Google Scholar, Cochrane Library, and ClinicalTrial.gov. The authors evaluated the efficacy and toxicity of combination treatment groups with regard to PFS, ORR, DCR, and AEs.

Six randomized controlled trials involving a total of 785 participants were included in the meta-analysis. Patients treated with the combined therapy showed no significant improvement in PFS (log hazard ratio, ‒0.228, 95 percent confidence interval [CI], ‒0.543 to 0.087; p=0.157), ORR (odds ratio [OR], 1.147, 95 percent CI, 0.577‒2.281; p=0.695), and DCR (OR, 1.578, 95 percent CI, 0.428‒5.821; p=0.493).

Similarly, there was no improvement seen in the incidence of AEs, including fatigue (OR, 0.833, 95 percent CI, 0.297‒2.333; p=0.728) and diarrhoea (OR, 2.268, 95 percent CI, 0.544‒9.448; p=0.261).

“Further research is needed to investigate the optimal sequencing of combination therapy in patients with NSCLC with different molecular targets to determine the most effective treatment strategy that can improve outcomes and quality of life for these patients,” the authors said.

“EGFR-tyrosine kinase inhibitors are standard therapy for patients with NSCLC with EGFR mutation; however, resistance is common,” they noted.