Sixth, quality of life and survival time are two equally important evaluating indicators for a treatment

Sixth, quality of life and survival time are two equally important evaluating indicators for a treatment. first-generation epidermal growth factor receptor tyrosine kinase inhibitors gefitinib and erlotinib have both been proven effective for treating advanced nonCsmall cell lung cancer (NSCLC), especially in East Asian patients. We conducted this meta-analysis to compare their efficacy Exatecan Mesylate and safety in treating advanced NSCLC in this population. Methods We systematically searched PubMed, ScienceDirect, The Cochrane Library, Scopus, Ovid MEDLINE, Embase, Web of Science, and Google Scholar for the relevant studies. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse effects (AEs) were analyzed as primary endpoints. Results We identified 5829 articles, among which 31 were included in the final analysis. Both gefitinib and erlotinib were effective for treating advanced NSCLC, with comparable PFS (95% confidence interval [CI]: 0.97C1.10, mutations, especially patients with certain clinical characteristics (Asian descent, female gender, never-smoker, adenocarcinoma) [5C8]. The EGFR TKIs gefitinib and erlotinib both Mouse monoclonal to CER1 achieve a higher response rate for treating NSCLC in East Asian countries than in the Western countries [9]. However, which EGFR TKI can achieve better efficacy is controversial. In a phase III randomized controlled trial (RCT), Urata reported a higher incidence of grade 3C4 skin rash but less alanine aminotransferase/aspartate aminotransferase elevation in the erlotinib arm. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were similar between the two groups [10]. In another phase III RCT, Yang reported that gefitinib and erlotinib had similar efficacy (PFS, OS, ORR) in NSCLC, with similar toxicities [11]. Some studies have shown that gefitinib has better anti-tumor efficacy or less toxicity for NSCLC [12, 13]. However, other studies have reported opposite results and have suggested that erlotinib is more effective [14, 15]. To resolve this controversy, we conducted a meta-analysis of related studies to compare the anti-tumor efficacy and adverse effects (AEs) of gefitinib and erlotinib for treating East Asian populations with NSCLC. Methods We conducted this meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Search strategy The relevant literature was retrieved using the following electronic databases: (1) PubMed; (2) ScienceDirect; (3) The Cochrane Library; (4) Scopus; (5) Web of Science; (6) Embase; (7) Ovid MEDLINE; and (8) Google Scholar. The last search was on February 14, 2018. The following terms were used: gefitinib, erlotinib, and Lung cancer. The complete search we used for PubMed was: (gefitinib [MeSH Terms] OR gefitinib [Text Word] OR IRESSA [Text Word] OR ZDl839 [Text Word]) AND (erlotinib [MeSH Terms] OR erlotinib [Text Word] OR Tarceva [Text Exatecan Mesylate Word] OR OSI-774 [Text Word]) AND (lung cancer [MeSH Terms] OR lung cancer [Text Word] OR lung carcinoma [Text Word] OR lung neoplasm [Text Word] OR NSCLC [Text Word]). The references of retrieved articles were also searched for further eligible articles. No language restriction was imposed. Selection criteria Articles that met the following criteria were included: (1) East Asian population with histologically or cytologically confirmed NSCLC based on the Eastern Cooperative Oncology Group; (2) compared gefitinib versus erlotinib; (3) outcomes were PFS, OS, ORR, disease control rate (DCR), and AEs. We excluded reviews without original data, meta-analyses, animal experiments, abstracts only, and studies with duplicated data. Data extraction Two investigators extracted the following data independently: first author, publication year, country, number of participants, participant characteristics (age, sex, stage of cancer, pathological type, line of treatment), anti-tumor efficacy indices (PFS, OS, ORR, DCR), and number of AEs (total AEs, grade 3C5 AEs). A third investigator resolved disagreements on all terms. Quality assessment The quality of RCTs was assessed using the 5-point Jadad scale, which contains questions on three main items: randomization, masking, and accountability of all Exatecan Mesylate patients. High-quality studies score??3 points [16]. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale (NOS, 9 points), which also contains questions on three main items: selection, comparability, and exposure. High-quality studies score 8C9 points; medium-quality studies score 6C7 points [17]. Statistical.