Network Meta-analysis Of Subsequent Treatments Of EGFR-WT And Unknown EGFR Mutation In Patients With Advanced Non-small Cell Lung Cancer

Objective: To systematic and meta-analysis the subsequent treatment of patients with advanced non-small cell lung cancer.Methods: We compiled search strategy and searched MEDLINE(1966-2015.11),EMBASE(1980-2015.11),Web of Science(1990-2015),CENTRAL(-2015.11),google scholar,clinicaltrial.gov and other search methods for eligible randomized controlled trials(RCTs)collecting all the eligible articles which studied subsequent treatments of EGFR-WT and unknown EGFR mutation in patients with advanced non-small cell lung cancer.By using Fast Stone?Adobe Photoshop?Enguage Digital,study characteristics,patient characteristics and inclusion and exclusion criteria were abstracted.We used the risk of bias tool to evaluate the quality of included Randomized clinical trials.Network meta-analysis using a Bayesian statistical model was conducted to combine the direct and indirect evidence.Overall survival(OS)and progression-free survival(PFS)were used as outcome.A Bayesian network meta-analysis was performed with WinBUGS and STATA to compare all treatments simultaneously.Results: We have searched 12501 articles.A total of 21 studies and 9335 patients were included.We included treatments such as: docetaxel,erlotinib,gefitinib,pemetrexed,ramucirumab,nivolumab,placebo,best supportive care.In terms of the results of OS,two studies were assigned to nivolumab groups,11 studies were assigned to docetaxel groups,eight studies were assigned to gefitinib groups,eight studies were assigned to pemetrexed groups,eight studies were assigned to erlotinib groups,four studies were assigned to placebo groups,one study was assigned to ramucirumab groups.The network results show that compared with control groups(placebo or best supportive care),nivolumab groups,docetaxel groups,erlotinib were associated with significant shorter OS.And Nivolumab groups were associated with significant shorter OS than docetaxel groups,gefitinib groups,erlotinib groups,pemetrexed groups,ramucirumab groups.There were no significant differences among other comparisons in OS and all interventions in PFS.