| Objective: Non-small Cell Lung Cancer(NSCLC)is a kind of high-deterioration as well as difficult-to-treat cancer,which is commonly associated with a variety of targets’ mutations.Anlotinib,which is a novel,oral and multi-targeted tyrosine inhibitor,can effectively inhibit the growth of the tumor.Nonetheless,it is lack of the systemic review of the safety and efficacy.This study makes a systemic review and meta-analysis of anlotinib,including ORR,PFS,OS and some treatment-related adverse events,so as to give some evidence for the future plan of the design of treatments from doctors.Recently,several clinical trials show,to some extent,extraordinary efficacy,like gefitinib,erlotinib,osimertinib and afatinib.However,the analysis of the risk of EGFR-TKI is not that much.Based on the studies which we could obtain today,the study made a systemic review of the risks of these targeted medications,so as to give the support to the physician when making decisions.Methods: By making a systemic review and meta-analysis of anlotinib and placebo,this study extracts the median PFS,median OS,ORR and some treatment-related adverse events,including fatigue,anorexia,diarrhoea,pharyngalgia,mucositis oral,hemoptysis,cough,hand-foot syndrome,proteinuria,hypertension,thyroid-stimulating hormone elevation,low density lipoprotein elevation,γ-glutamyltransferase elevation and blood bilirubin elevation,so as to obtain the difference between anlotinib group and placebo group.By the performance of a meta-analysis of clinical trials,which are randomized and contain EGFR-TKI arm and placebo or chemotherapy arm,we made an indirect comparison of extracting the data of EGFR-arm of osimertinib or gefitinib or erlotinib or afatinib,so as to analyze the risk of toxic death,grade 3 or more adverse events,treatment discontinuation and some common adverse effects.We made several pair-comparison groups,including(1)osimertinib vs gefitinib,(2)osimertinib vs erlotinib,(3)osimertinib vs afatinib,(4)gefitinib vs erlotinib;(5)gefitinib vs afatinib;(6)erlotinib vs afatinib,to compute relative risks.Results: As for the systemic review of anlotinib,there were totally 580 patients included in this analysis.The results show that,compared placebo group,anlotinib shows greater power in the efficacy part,including PFS,OS and ORR.For the incidence of the total adverse events,anlotinib shows significant difference from placebo group in fatigue,anorexia,diarrhoea,pharyngalgia,mucositis oral,hemoptysis,cough,hand-foot syndrome,proteinuria,hypertension,thyroid-stimulating hormone elevation,low density lipoprotein elevation,γ-glutamyltransferase elevation and blood bilirubin elevation.For the safety(grade≥3adverse events incidence)of anlotinib and placebo,only the incidence of hypertension appear significant difference,whereas other items are not.As for risk evaluation on the adverse effects of target therapies on EGFR related mutation,there were totally 6555 patients included in this analysis.The results show that,the incidence of EGFR-TKI related toxic death 2.1%,grade 3 or more adverse events 38.8%,treatment discontinuation 9.2%.In addition,the incidence of adverse effects are rash 61.2%,diarrhea 49.2%,stomatitis 25.8%,dry skin 25.5%,paronychia24.5%,fatigue 20.9%,appetite loss 20.3%,pruritus 18.2%,nausea 15.9% and vomiting 12.6%.Conclusion: Based on the meta-analysis of anlotinib and placebo,anlotinib group gains better benefits of PFS,OS and ORR,and also higher risks of obtaining side effects.However,compared with placebo group,anlotinib only shows higher risks of having grade≥3 hypertension,whereas other items are not.Based on the study,patients show the tolerance of the common EGFR-TKI,which means the risks of them should also be put into full consideration when the physicians making the treatment regimen,so as to provide stronger and more reliable protection of the patients. |
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