Title: Gefitinib, Erlotinib or Afatinib for EGFR Mutated NSCLC patients? A Meta-Analysis and Indirect Comparison on the Efficacy of First-Line Tyrosine Kinase Inhibitors
Abstract: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) including gefitinib, erlotinib and afatinib have proven efficacy in terms of progression-free survival (PFS) and overall survival (OS). However, these TKIs are not compared head-to-head in RCTs. This study aimed to compare the efficacy of first-line gefitinib, erlotinib and afatinib. A systematic review was conducted by searching electronic databases for eligible publications. Meta-analysis and indirect comparisons were performed. Pooled data on PFS and OS were calculated to estimate and to compare the efficacy of each TKI. Seven phase III RCTs were included in our analysis. 1,745 EGFR-mutated patients were included. Erlotinib (HR: 0.246, 95%CI: 0.108 - 0.560) and afatinib (HR: 0.405, 95%CI: 0.198 - 0.826) showed statistically significant efficacy on PFS in comparison with chemotherapy, but were not superior on OS. Gefitinib had no statistically significant effect on both PFS and OS in comparison to chemotherapy. Indirect comparisons did not show statistically significant difference between gefitinib, erlotinib and afatinib on both PFS and OS. Our study showed that gefitinib, erlotinib and afatinib had similar efficacy. None of the TKIs were superior for the front-line NSCLC.