Epidermal growth factor receptor-tyrosine kinase inhibitors ( EGFR-TKIs ) are a critical member of systemic therapy for advanced non-small-cell lung cancer ( NSCLC ).
Erlotinib ( Tarceva ) is the first-generation EGFR-TKIs, the National Comprehensive Cancer Network ( NCCN ) guidelines recommend it as a first-line agent in patients with sensitizing EGFR mutations.
However, the safety of Erlotinib plus chemotherapy ( CT ) or Erlotinib alone for advanced NSCLC remains controversial.
A systematic meta-analysis to determine the overall risk of neutropenia and leukopenia associated with Erlotinib was carried out.
Researchers have identified 12 eligible studies involving 3932 patients. Erlotinib plus chemotherapy or alone relative to chemotherapy is associated with significantly decreased risks of neutropenia and leukopenia in patients with advanced NSCLC ( RR=0.38; 95% CI, 0.21-0.71; P = 0.00; incidence: 9.9 vs 35.2% ) and ( RR=0.32; 95% CI, 0.11-0.93; P = 0.04; incidence: 3.5 vs. 11.6% ), respectively.
The subgroup analysis by Erlotinb with or without chemotherapy showed that Erlotinib combine with chemotherapy have no significance decrease the relative risks of neutropenia or leukopenia ( RR=0.98; 95% CI, 0.78-1.23; P = 0.87; incidence: 26.2 vs 30.5% ) and ( RR=0.81; 95% CI, 0.34-1.95; P = 0.64; incidence: 6.5 vs 9.3% ), respectively.
However, Erlotinib alone could decrease incidence of neutropenia ( RR=0.14; 95% CI, 0.07-0.27; P = 0.00; incidence: 3.7 vs 40.8% ) or leukopenia ( RR=0.07; 95% CI, 0.01-0.45; P = 0.01; incidence: 0.8 vs. 15.7% ).
The power analysis suggests that a power of 61.31% was determined to detect an RR of 0.38 for neutropenia, and 78.03% for an RR of 0.32 for leukopenia.
The present meta-analysis suggested that Erlotinib could decrease the incidence of neutropenia and leukopenia in patients with advanced NSCLC undergoing Erlotinib regardless of whether combined with chemotherapy or not.
The subgroup analysis revealed that Erlotinib combine with chemotherapy did not affect the incidence; however, Erlotinib alone could significantly decrease the incidence of neutropenia and leukopenia compared with chemotherapy alone. ( Xagena )
Zhou JG et al, Medicine ( Baltimore ) 2015;94:e1719