Comparison Of The Efficacy And Safety Of Afatinib And Osimertinib In The Treatment Of EGFR Exon20 Insertions Mutation Non-small Cell Lung Cancer :a Meta-analysis

Objective:The complete remission rate,partial remission rate,disease stability rate,disease control rate,objective remission rate,total adverse reaction rate and severe adverse reaction rate of patients with EGFR20 insertion mutant non-small cell lung cancer treated with afatinib and osimertinib were analyzed by Meta analysis,in order to provide basis for clinical rational drug use.Methods:A computer search of Pubmed,medline,Web of science,China Journal full-text Database(CNKI),Wanfang Database(Wanfang)and VIP was conducted to obtain the articles in accordance with the inclusion study.The search time limit was from the establishment of the database to March 2021.After collecting the relevant literatures about the efficacy and safety of afatinib and osimertinib in the treatment of EGFR20 insertion mutation non-small cell lung cancer,and further searching all the related studies mentioned in the included literature,after extracting the data.Meta analysis was performed using R statistical software,and the outcome indicators included complete remission(complete response,CR)and partial remission(partial response.PR),disease stability(stable disease,SD),objective effective rate(ORR=CR+PR),disease control rate(DCR=CR+PR+SD).The total incidence of adverse reactions and the incidence of severe adverse reactions were compared to compare the efficacy and safety of the two targeted drugs.Results:A total of 372 patients with non-small cell lung cancer with EGFR20 insertion mutation were included in 15 literatures,including afatinib group(n = 208)and osimertinib group(n = 164).Pairwise comparison of drug efficacy by meta analysis:1.Among the 70 cases reported in the CR,Yang study,2 cases were in complete remission with afatinib,while no complete remission was found in the group treated with osimertinib.2.For PR,afatinib group: PR=0.162 95% CI:(0.112,0.219),osimertinib group:[PR=0.101 95% CI:(0.023,0.180)] the partial remission rate of afatinib group was higher than that of osimertinib group.3.For SD,afatinib group: [SD=0.528 95% CI:(0.463,0.602)],osimertinib group: [SD=0.557 95% CI:(0.423,0.734)] the disease stability rate of osimertinib group was higher than that of afatinib group.4.For DCR,afatinib group: [DCR=0.64 95% CI:(0.529,0.743)],osimertinib group: [DCR=0.717 95% CI:(0.519,0.879)] the disease control rate of osimertinib group was higher than that of afatinib group.5.For ORR,afatinib group: [ORR=0.156 95% CI:(0.108,0.205)],osimertinib group: [ORR=0.101 95% CI(0.023,0.180)] the objective remission rate of afatinib group was higher than that of osimertinib group.6.For the total adverse reaction rate,the afatinib group: [total adverse reaction rate = 0.51 95% CI:(0.031,0.977)],and the osimertinib group: [total adverse reaction rate = 0.616 95% CI:(0.344,1.000)] the total adverse reaction rate of osimertinib group was higher than that of the afatinib group.For the severe adverse reaction rate,the afatinib group: [severe adverse reaction rate = 0.031 95%CI:(0.00,0.196)],the osimertinib group: [severe adverse reaction rate = 0.05795% CI:(0.000,0.334)] the severe adverse reaction rate of osimertinib was higher than that of the afatinib group.Conclusion:In terms of the difference in clinical efficacy between afatinib and osimertinib in the treatment of patients with EGFR20 insertion mutation non-small cell lung cancer,afatinib had better objective effective rate,partial remission rate,that is,more clinical remission,osimertinib had better disease control rate and disease stability rate;for adverse reactions,the total adverse reactions and severe adverse reactions in afatinib group were relatively less.