Meta-analysis Of The Efficacy And Safety Of EGFR-TKIs Plus Bevacizumab Versus Egfr-tkis Alone In Non-small Cell Lung Cancer

Objective: To compare the treatment of first-generation EGFR-TKIs plus bevacizumab with that of EGFR-TKIs alone in advanced or metastatic non-small cell lung cancer,and evaluate and tell the differences of following aspects,disease control rate,objective response rate,median progress-free survival time,and incidence of adverse reactions.Aim to provide better evidence of treatment options.Method: First of all,Researchers used computers to screen and search articles in various databases,including The Cochrane Library,EMbase,Pubmed,VIP,CNKI,Wan Fang and so on,with a theme of randomized controlled trials of first-generation EGFR-TKIs combined with bevacizumab compared with EGFR-TKIs alone in non-small cell lung cancer,retrieval date until October 2019.Literature screening adhered to strict inclusion and exclusion criteria.Then the researchers accomplish the whole progress of extracting basic information and available data,selecting effect quantity,analyzing heterogeneity and source,selecting statistical analysis model and analyzing final result.The Rev Man 5.3 software was used to analyze the data and draw funnel plot to evaluate the publication bias,and the Cochrane bias risk assessment tool was used to evaluate the quality of the study.Results: A total of 9 articles were included,including 1482 patients.Meta-analysis showed that the treatment of EGFR-TKIs plus Bevacizumab could improve DCR(OR=1.86,95% CI [1.40,2.46],P<0.0001)and ORR(OR=1.90,95%CI [1.46,2.48],P<0.00001)in EGFR mutation-positive advanced non-small cell lung cancer,compared with the treatment of EGFR-TKIs alone,the difference was statistically significant.Meanwhile,m PFS[HR=0.62,95%CI(0.54,0.71),P<0.00001]was different,the difference was statistically significant.Safety: In terms of ≥grade Ⅲ adverse events,the group of EGFR-TKIs plus bevacizumab had higher rate of rash(OR=1.64,95%CI[1.20,2.24],P=0.002),hypertension(OR=5.21,95%CI[2.41,11.29],P<0.0001)and proteinuria(OR=7.54,95%CI[2.63,21.60],P=0.0002).There was no significant difference in diarrhea(OR=1.09,95%CI[0.54,2.17],P=0.82),and hemorrhage(OR=1.74,95%CI[0.74,4.09],P=0.21)between two groups.Conclusion: The treatment of EGFR-TKIs plus Bevacizumab in patients with non-small cell lung cancer can improve m PFS,ORR and DCR.However,the group of EGFR-TKIs plus bevacizumab showed increased incidence of adverse events such as rash,hypertension,proteinuria.