Table 4. Quantitative analyses of included clinical trials: tyrosine kinase inhibitors (TKI) versus chemotherapy
Study [ref.]Patients treated with TKI nPFSORR %Overall survivalIncidence of grade 3-5 adverse events# >1% of patientsRate of discontinuation due to adverse events %
NEJ002 [12, 23]11410.8 months versus 5.4 months; HR 0.32 (95% CI 0.24–0.44), p<0.00174 versus 31; p<0.00127.7 months versus 26.6 months; HR 0.89 (95% CI 0.63–1.24), p = 0.483AST/ALT elevation 25%, rash 5.3%, appetite loss 5.3%, fatigue 2.6%, pneumonitis 2.6%Not reported
WJTOG3405 [13, 25]51 for PFS (stage IIIb/IV subgroup) 86 for overall survival8.4 months versus 5.3 months; HR 0.33 (95% CI 0.21–0.54), p<0.0001 (stage IIIb/IV subgroup)62 versus 32++; p<0.000136 months versus 39 months; HR 1.19 (95% CI 0.771.83), p = 0.443Whole population (including those with recurrent disease): ALT elevations 27.6%, AST elevations 16.1%, fatigue 2.3%, rash 2.3%, diarrhoea 1.1%, paronychia 1.1%, nausea 1.1%, sensory disturbance 1.0%16
IPASS+ [8, 14]1329.5 months versus 6.3 months; HR 0.48 (95% CI 0.36–0.64), p<0.00171 versus 47; p<0.00121.6 months versus 21.9 months; HR 1.00 (95% CI 0.76–1.33), p = 0.990)Whole population: diarrhoea 3.8%, neutropenia 3.7%, rash or acne 3.1%, anaemia 2.2%, anorexia 1.5%, leukopenia 1.5%Whole population, 7
EURTAC§ [9, 19]869.7 months versus 5.2 months; HR 0.37 (95% CI 0.25–0.54), p<0.000158 versus 15; p-value not reported19.3 months versus 19.5 months; HR 1.04 (95% CI 0.65–1.68), p = 0.87Rash 13%, fatigue 6%, diarrhoea 5%, AST/ALT 2%, anaemia 1%, neuropathy 1%, arthralgia 1%, pneumonitis 1%13
EURTAC [9, 19]8610.4 months versus 5.4 months; HR 0.47 (95% CI 0.28–0.78), p = 0.0030
LUX-Lung 3##23011.1 months versus 6.9 months; HR 0.58 (95% CI 0.43–0.78); p = 0.00156 versus 23; p = 0.00128.1 months versus 28.2 months; HR 0.91 (95% CI 0.66–1.25), p = 0.55 (yet immature)Rash/acne 16.2%, diarrhoea 14.4%, paronychia 11.4%, stomatitis/mucositis 8.7%, decreased appetite 3.1%, vomiting 3.1%, fatigue 1.3%8
LUX-Lung 3§ [15]23011.1 months versus 6.7 months; HR 0.49 (95% CI 0.37–0.65); p = 0.00169 versus 44; p = 0.001
OPTIMAL [10, 11]8213.1 months versus 4.6 months; HR 0.16 (95% CI 0.10–0.26), p<0·000183 versus 36; p<0.000122.7 months versus 28.9 months; HR 1.04 (95% CI 0.69–1.58), p = 0.69 (yet immature)ALT 4%, rash 2%1
LUX-Lung 6¶¶ [16]24211.0 months versus 5.6 months; HR 0.28 (95% CI 0.20–0.39), p<0.000167 versus 23; p<0.0001Not reported; immatureRash/acne 14.6%, diarrhoea 5.4%, stomatitis/mucositis 5.4%, ALT increase 1.7%, decreased appetite 1.3%6
LUX-Lung 6§ [16]24213.7 months versus 5.6 months; HR 0.26 (95% CI 0.19–0.36), p<0.000174 versus 31; p-value not reported
ENSURE¶¶ [17]11011.0 months versus 5.6 months; HR 0.42 (95% CI 0.27–0.66), p<0.000163 versus 34; p = 0.0001Not reported; immatureRash 6.4%, diarrhoea 1.8%§§3
ENSURE§ [17]11011.0 months versus 5.5 months; HR 0.34 (95% CI 0.22–0.51), p<0.0001)
  • NEJ002: North East Japan 002; WJTOG: West Japan Thoracic Oncology Group; IPASS: Iressa Pan-Asia Study; EURTAC: European Randomised Trial of Tarceva versus Chemotherapy; PFS: progression-free survival; ORR: overall response rate; HR: hazard ratio; ALT: alanine transaminase; AST: aspartate aminotransferase. #: TKI treatment only; : TKI treatment only, independent of relation to study drug; +: mutation-positive subgroup; §: investigator assessed; ƒ: investigator assessment based on 45 patients, independent review based on 31 patients treated with erlotinib; ##: independent review (primary end-point); ¶¶: independent assessed; ++: measurable disease but stage-independent (TKI and chemotherapy combined n = 117); §§: only adverse events of special interest were reported.