The resistance of non-small cell lung cancer (NSCLC) to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has been brought into focus. COX-2 signal pathway was found to be closely related to EGFR signal pathway by recent researches, and there has been a growing interest to focus the researches on whether COX-2 pathway inhibition improves the efficacy of EGFR-TKIs in treating advanced NSCLC. In this review, we will illustrate recent advances of combined inhibition of EGFR and COX-2 signal pathways in NSCLC therapy.
Objective To compare the long-term cost-utility of three first-generation EGFR-TKIs targeted drugs, gefitinib, icotinib, and erlotinib as first-line treatments for advanced non-small cell lung cancer (NSCLC). Methods Real-world data were collected from 1 511 patients with advanced NSCLC treated with first-generation EGFR-TKIs as first-line treatment at West China Hospital of Sichuan University from 2009 to 2019. A three-state Markov model was established to evaluate the clinical efficacy, safety and cost-utility of three first-generation EGFR-TKIs targeted drugs. The transition probability of each state was obtained by survival analysis, the direct and indirect costs were calculated by the bottom-up method, the health utility value was obtained through literature research, the incremental cost effectiveness ratio (ICER) and quality-adjusted life years (QALYs) were calculated, and sensitivity analyses and Monte Carlo simulations were performed. Results There was no significant difference in clinical efficacy among the three first-generation EGFR-TKIs in the treatment of NSCLC. The incidence of skin rash and liver injury caused by gefitinib was significantly higher than that caused by icotinib and erlotinib (P<0.05). The average economic burden of patients treated with icotinib was the lowest (CNY 192 535.3) (P<0.01). The cost-utility ratio of icotinib (CNY 132 985.9/QALYs) was much lower than that of gefitinib (CNY 205 005.3/QALYs) and erlotinib (CNY 172 893.1/QALYs). Conclusion Compared with the three first-generation EGFR-TKIs drugs, icotinib is the most cost-effective.
ObjectiveTo systematically evaluate the efficacy and safety of epidermal growth factor receptortyrosine kinase inhibitors (EGFR-TKIs) as the first-line treatment for patients with advanced non-small cell lung cancer (NSCLC). MethodDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015) , CBM, CNKI, VIP and WanFang Data were electronically searched from inception to March 2015, to collect randomized controlled trials (RCTs) about EGFR-TKIs versus chemotherapy for advanced NSCLC patients. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. ResultsA total of 9 RCTs involving 3 841 patients were included. The results of meta-analysis showed that: for patients with EGFR mutation-positive, the rate of progression-free survival (PFS) (HR=0.41, 95%CI 0.31 to 0.54, P<0.000 01) , objective response rate (ORR) (RR=2.23, 95% CI 1.73 to 2.87, P<0.000 01) and quality of life (QoL) in the EGFR-TKI group were superior to the chemotherapy group; There was no statistical difference between two groups in rate of overall survival (OS) (HR=1.04, 95% CI 0.88 to 1.24, P=0.62) . The incidences of diarrhea (RR=3.81, 95% CI 2.15 to 6.76, P<0.001) and rash (RR=8.14, 95% CI 3.55 to 18.68, P<0.001) were significantly higher, but the incidence of blood toxicity was lower in the EGFR-TKI group that those in the chemotherapy group. ConclusionsCurrent evidence shows EGFR-TKI is superior to chemotherapy for advanced NSCLC patients with EGFR mutation-positive. However, due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.