| Background:Anaplastic lymphoma kinase(ALK)has been shown to be a specific tyrosine kinase targets of non-small cell lung cancer(NSCLC),and it is also an important therapeutic target in NSCLC after epidermal growth factor receptor(EGFR).Crizotinib is an oral tyrosine kinase inhibitor(TKI)targeting ALK,it has been associated with marked clinical effect to NSCLC of chromosomal rearrangements of ALK in more and more single-group studies.However,whether crizotinib is superior to standard chemotherapy with respect to efficacy is unknown.The present study aimed to compare crizotinib and standard chemotherapy in patients with advanced ALK-positive NSCLC.Methods:We searched the PubMed and Embase databases for journals published until December of 2017,the key search terms are“Crizotinib”and“Non-small cell lung cancer”and language of eligible articles was restricted to English.After screening the retrieved articles according to the enacted inclusion and exclusion criteria,and the date of final inclusion studies were combined and analyzed.Jadad scale was used to identify all eligible randomized controlled trials(RCT)quality and Newcastle–Ottawa scale(NOS)to assess the quality of cohort study and case-control study.We extract the characteristics of the include studies,such as the name of the first author,the year of publication,the country of the study,the basic information of the patient and the outcomes measure included overall survival(OS),progression-free survival(PFS),objective response rate(ORR)?disease control rate(DCR)and toxicity and side effects.We used hazard ratio(HR),odds ratio(OR)and 95%confidence intervals(95%CIs)to calculate the effect measures by Review Manager software version 5.3.Q test and I~2 test were used to evaluate heterogeneity,and the P values>0.1 and I~2<50%,the fixed-effects model was chosen to analysis the data.Otherwise,the P values<0.1 and/or I~2>50%indicated significant heterogeneity,we used the random-effects model.Forest plots were used to show the pooled results,and a funnel plot was utilized to test for publication bias between include studies.Results:After retrieving relevant search words in PubMed and EMBASE databases,3708related articles were retrieved,and 3701 articles were excluded according to the inclusion and exclusion criteria.The final 7 articles including 3 English abstracts were included in this meta-analysis.The patients treated with crizotinib presented a longer PFS compared with standard chemotherapy(HR=0.43,95%CI=0.34,0.54,P<0.01,n=5),but there is no significant advantage in OS(HR=0.85,95%CI=0.70-1.04,P=0.11,n=3).We can also find a better ORR(OR=5.56,95%CI=4.28,7.49,P<0.01,n=6)and DCR(OR=3.50,95%CI=2.40,5.11,P<0.01,n=5)in crizotinib group.In terms of toxicity and side effects,crizotinib is more likely to develop vision disorder,vomiting,diarrhea and liver injury than standard chemotherapy.In comparison with nausea,constipation and toxic effects above Grade 3,there is no significant difference between crizotinib and standard chemotherapy.Conclusion:The crizotinib therapy obviously prolonged PFS,DCR and ORR for patients with advanced ALK-positive NSCLC compared with standard chemotherapy.However,the analysis of OS showed no significant improvement with crizotinib as compared with standard chemotherapy.In conclusion,crizotinib is superior to standard chemotherapy in patients with advanced ALK-positive NSCLC. |
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