OBJECTIVES:

Osimertinib is a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) recommended for the treatment of the patients with T790M-positive advanced non-small cell lung cancer (NSCLC) resistant to first or second-generation EGFR TKI. There were several real-world studies on the effectiveness of osimertinib. However, most studies involved highly heterogeneous treatment lines. Therefore, our aim was to compared the effectiveness of osimertinib as second-line to later-lines treatment in patients with T790M-positive advanced NSCLC.

METHODS:

We conducted a systematic review and meta-analysis to compare the effectiveness of osimertinib as second-line or later-lines in T790M-positive advanced NSCLC patients. We systematically search for observational studies on PubMed, Embase and the Cochrane library databases from January 2020 to December 2021. Two authors independently screened the titles and abstracts of eligible articles, extracted data, assessed the risk of bias and evaluated the quality of evidence. Pooled effectiveness of progression free survival (PFS) and overall survival (OS) were estimated using the generic inverse variance method.

RESULTS:

A total of 5 studies with 273 second-line and 282 later-lines osimertinib users met the criteria and were included. The median OS and PFS in second-line users were range from 20.7 to 27.7 months and 9.4 to 15.5 months, respectively. Among later-lines users, the median OS and PFS were range from 18.0 to 32.1 months and 9.7 to 12 months, respectively. There was only one study reported hazard ratio of PFS between group (HR: 0.71, 95% CI: 0.36-1.4) for pooled analysis.

CONCLUSIONS:

There was no significantly clinical difference between second-line and later-lines osimertinib users. It means that osimertinib, a salvage drug for T790M-positive advanced NSCLC patients, had demonstrated efficacy even when administered as later-lines treatment.