Abstract:
First-generation EGFR-TKIs (gefitinib/erlotinib) and second-generation EGFR-TKI (afatinib) have become
the current first-line treatments for EGFR-mutated non-small cell lung cancer (NSCLC), however, the effects of using
second-generation EGFR-TKIs compared to those of using first-generation EGFR-TKIs as a first-line treatment for
NSCLC patients with EGFR mutations remain unknown. We conducted this meta-analysis based on 4 retrospective and
2 randomized controlled studies published between 2016 and 2018. We surveyed the effectiveness of
afatinib/dacomitinib and gefitinib/erlotinib as first-line treatments for stage III-IV EGFR-mutated NSCLC patients. The
combined hazard ratio (HR) for the progression free survival (PFS) of second-generation EGFR-TKI group versus that
first-generation drug group was 0.64 [95% confidence interval (95% CI) 0.55–0.74; P<0.001], demonstrating a superior
PFS in the second-generation group. This outcome coincided with the subgroup analyses comparing the PFS of patients
with EGFR exon 19 deletion (HR = 0.68 [95% CI 0.55–0.83; P = 0.0002]) or L858R mutation (HR = 0.64 [95% CI 0.51–
0.81; p=0.0002]). Meanwhile, second-generation drugs could to significantly improve the time to progression (TTFs)
compared to first-generation drugs (HR = 0.81 [95% CI 0.67–0.89; P = 0.03]). Afatinib and dacomitinib may be the
superior first-line treatment for advanced NSCLC patients with EGFR mutations
