First-generation EGFR-TKI plus chemotherapy versus EGFR-TKI alone as first-line treatment in advanced NSCLC with EGFR activating mutation: a systematic review and meta-analysis of randomized controlled trials

The role of addition of chemotherapy (CT) to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) for EGFR-mutated non-small cell lung cancer (NSCLC) has not been well established. The aim of this meta-analysis was to evaluate efficacy and toxicity of EGFR-TKI in combination with CT compared to EGFR-TKI monotherapy as first-line treatment in advanced NSCLC harboring EGFR activating mutation. A systematic literature search of randomized controlled trials using Cochrane Library, PubMed, Embase, and Web of Science, was performed up to Jan. 7th, 2020. A total of eight randomized trials involving 1,349 advanced NSCLC patients with sensitive EGFR mutation were included in the meta-analysis. All patients in both groups received first-generation TKI as first-line treatment. The pooled hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS) were 0.56 (95% CI=0.50-0.64; P