Efficacy and safety of anaplastic lymphoma kinase inhibitors for non–small cell lung cancer: A systematic review and network meta‐analysis
Open Access
- 13 March 2023
- journal article
- review article
- Published by Wiley in Thoracic Cancer
- Vol. 14 (10), 929-939
- https://doi.org/10.1111/1759-7714.14824
Abstract
Background: To assess the efficacy and safety of anaplastic lymphoma kinase inhibitors (ALKIs) for the treatment of advanced-stage ALK rearrangement-positive non-small cell lung cancer (NSCLC).Methods: We searched PubMed, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) that included patients with ALK-positive NSCLC receiving ALKIs. The outcomes of the study included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (TRAEs) of grade >= 3.Results: A total of 12 RCTs consisting of 3169 patients with eight treatment options were included in this study. Our results showed that ALKIs have superior efficacy in OS, PFS, and ORR than chemotherapy or crizotinib (first-generation ALKI). Our study showed that only alectinib has a significant improvement in OS compared to chemotherapy (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.40-0.94). Alectinib appeared to have better OS than crizotinib (HR, 0.66; 95% CI, 0.45-0.95). Ensartinib has a significant PFS advantage over alectinib (HR, 0.62; 95% CI, 0.40- 0.96). The surface under the ranking curve indicated that ensartinib (99.0%) was the highest rank regarding PFS. Moreover, both ensartinib and ceritinib showed significantly higher TRAEs of grade >= 3 compared with chemotherapy (risk ratios [RR], 2.74; 95% CI, 1.45-5.18; RR, 1.80; 95% CI, 1.26-2.57, respectively).Conclusions: These results indicated that alectinib could be associated with the best therapeutic efficacy and well-tolerance AEs in the treatment of ALK-positive NSCLC.Keywords
This publication has 42 references indexed in Scilit:
- P-glycoprotein Mediates Ceritinib Resistance in Anaplastic Lymphoma Kinase-rearranged Non-small Cell Lung CancerEBioMedicine, 2015
- The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and ExplanationsAnnals of Internal Medicine, 2015
- Alectinib: a novel second generation anaplastic lymphoma kinase (ALK) inhibitor for overcoming clinically-acquired resistanceActa Pharmaceutica Sinica. B, 2015
- The efficacy and safety of crizotinib in the treatment of anaplastic lymphoma kinase-positive non-small cell lung cancer: a meta-analysis of clinical trialsBMC Cancer, 2014
- Antitumor activity of the selective ALK inhibitor alectinib in models of intracranial metastasesCancer Chemotherapy and Pharmacology, 2014
- Selective ALK inhibitor alectinib with potent antitumor activity in models of crizotinib resistanceCancer Letters, 2014
- Crizotinib versus Chemotherapy in AdvancedALK-Positive Lung CancerThe New England Journal of Medicine, 2013
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986