Vandetanib For Advanced Non-small Cell Lung Cancer: A Meta-analysis

Background and objective：Lung cancer is one of the leading causes of cancer deaths in the world. Non-small celllung cancer (NSCLC) are about85%of all lung cancers, Lots of patients are diagnosedwith unresectable or metastatic disease，Chemotherapy remains important in the treatmentof advanced NSCLC, but most of patients have disease progression and finally die fromadvanced NSCLC. With the development of molecular biology of cancer, some drugs areaccepted as second-line treatments for advanced NSCLC including docetaxel, pemetrexed,erlotinib,gefitinib, but these has not shown superior efficacy in advanced NSCLC.Therefore,it is necessary for new therapy. Vandetanib is molecular targeted drug which could inhibitvascular endothelial growth factor receptor(VEGFR) and endothelial growth factorreceptor(EGFR) dependent signaling，and it is also an inhibitor of rearranged duringtransfection (RET) receptor tyrosine kinase. The aim of this study is to observe the efficacyand safety of vandetanib as second-line treatment for advanced NSCLC.Methods：We searched relevant randomized controlled trials (RCTs) from PubMed, Medline,Embase, Cochrane Library, China Journal Full-text Database.The terms include vandetanib,ZD6474, non-small cell lung cancer, second-line therapy. We have done quality assessmentof qualified RCTs assessed by the exclusion and inclusion criteria and then selectedqualified literature,at the last,perform meta-analysis using RevMan5.0provided by theCochrane Collaboration.Results：Five random trials with a total of3416patients were included into the meta-analysis.There was a statistical differences of progression-free survival (PFS)(P=0.01,OR=1.23,95%CI:1.05-1.45), partial responses (PR)(P<0.00001,OR=2.15,95%CI:1.59-2.93) anddisease control (DC)(P=0.004,OR=1.22,95%CI:1.06–1.40) in the vandetanib group, butoverall survival (OS)(P=0.21,OR=1.11,95%CI:0.94-1.32) and stable disease(SD)(P=0.35, OR=1.11,95%CI:0.89-1.39)were no difference compared with control group. There werestatistical differences of diarrhea(P<0.00001,OR=1.59,95%CI:1.38–1.83),nausea(P=0.0001,OR=0.69,95%CI:0.57–0.83),rash(P<0.00001,OR=1.64,95%CI:1.44–1.86)andvomiting (P=0.0006,OR=0.72,95%CI:0.60–0.87)in the vandetanib group. There were nodifference incidences of fatigue(P=0.88,OR=0.99,95%CI:0.85–1.15), cough(P=0.88,OR=0.99,95%CI:0.83–1.17), anorexia(P=0.39,OR=0.93,95%CI:0.80–1.09), dyspnea(P=0.27,OR=0.91,95%CI:0.76–1.08)and constipation(P=0.38,OR=0.91,95%CI:0.73–1.13)compared with control group.Conclusions：Vandetanib might have more superior efficacy as second-line treatment for NSCLC,but the safety of vandetanib have not demonstrate significantly advantage.