Are multiple treatments better than one for treating advanced NSCLC?

This meta-analysis summarizes studies that looked at the effectiveness of erlotinib in combination with chemotherapy. This review is specific for patients with advanced NSCLC. The authors concluded that this combination is effective for NSCLC patients who have never smoked and who have EGFR mutations.

Lung cancer is commonly diagnosed at an advanced stage where surgery is no longer a treatment option. Drug resistance to chemotherapy is also a common problem for these patients. Erlotinib (Tarceva) is an anti-cancer drug that targets a specific genetic mutation (change) called EGFR in non-small-cell lung cancer (NSCLC). Studies have shown conflicting data on whether erlotinib would be an effective treatment combined with chemotherapy. It is unknown whether it would be more beneficial than chemotherapy alone. It is also unknown whether it would be beneficial administering the drugs on different days of the treatment cycle (known as intercalated).

This meta-analysis examined whether chemotherapy in combination with erlotinib is effective for patients with advanced NSCLC. Progression free survival (PFS, time from beginning trial until disease progression) and overall survival (OS, time from beginning trial until death from any cause) were reported.

The authors identified 9 trials with a combined 3599 patients. Group 1 included patients who received chemotherapy and erlotinib. Group 2 included patients who received chemotherapy alone.

Overall, the chance of a longer PFS was 24% higher for group 1 patients than for group 2 patients. In particular, group 1 patients who had intercalated drug administration had a 33% increase. 

There was an 18% increase in the chance of longer OS for group 1 patients who had intercalated administration compared to group 2 patients.

There was no significant difference in PFS or OS for group 1 patients who had continuous administration of erlotinib and chemotherapy compared to group 2 patients.

Group 1 patients who had never smoked and who had EGFR mutations had the most benefit from the combined drugs. The chance of a longer PFS was 54% higher and OS was 36% higher for never smokers. The chance of a longer PFS was 69% higher and a longer OS was 48% higher in those with EGFR mutations.

There were more incidences of side effects for group 1 patients than group 2. Group 1 patients had 48% higher risk of anemia, a 12.34-fold higher risk of rash and a 4.25-fold higher risk of diarrhea.

The authors concluded that chemotherapy and erlotinib is a viable treatment option for NSCLC patients who have never smoked and have EGFR mutations. They also suggested that treatment should be intercalated.