Is there a benefit of first- or second-line crizotinib in locally advanced or metastatic anaplastic lymphoma kinase-positive non-small cell lung cancer? a meta-analysis

// Hao Hu 1, * , Wei Qing Lin 2, 6, * , Qian Zhu 3, * , Xiong Wen Yang 1 , Hai Dong Wang 4 , Yu Kang Kuang 5 1 Department of Thoracic Surgery, Medical College of Nanchang University, Nanchang, 330006, China 2 Department of Integrated Chinese and Western Medicine, Medical College of Nanchang University, Nanchang, 330006, China 3 Department of Biotherapy, Sun Yat-sen University Cancer Center, Guangdong, 510060, China 4 Department of General Surgery, Medical College of Nanchang University, Nanchang, 330006, China 5 Department of Thoracic Surgery, Medical College of Nanchang University, Jiangxi Province Tumor Hospital, Nanchang, 330006, China 6 Department of Integrated Chinese and Western Medicine, Jiangxi Province People's Hospital, Nanchang, 330006, China * These authors contributed equally to this work Correspondence to: Yu Kang Kuang, email: kuangyukang@aim.com Keywords: meta-analysis, crizotinib, anaplastic lymphoma kinase, non-small cell lung cancer Received: April 23, 2016      Accepted: October 31, 2016      Published: November 07, 2016 ABSTRACT Background: Crizotinib show a promising efficacy in patients with anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC). However, differences in efficacy for first- and second-line crizotinib are unclear. Results: The pooled overall response rate and progression-free survival were 65% and 9.38 months, respectively. In the subgroup analysis, first-line crizotinib showed a higher trend of overall response rate and longer trend of progression-free survival although there was no statistical difference between first-line and second-line crizotinib (74%, 11.28 months vs. 65%, 8.12 months, respectively; fixed effects model). Moreover, overall response rate between Asians and Caucasians were similar (67% and 66%, respectively; fixed effects model). Materials and Methods: A comprehensive search of MEDLINE, EMBASE, WEB OF SCIENCE and the COCHRANE databases from their inception to February 2016 was performed to identify clinical trials in English-language journals. Pooled overall response rate, progression-free survival and differences between first- and second-line crizotinib were estimated. Moreover, overall response rate between Asians and Caucasians were also estimated. Conclusions: First-line crizotinib may more effective than second-line crizotinib for patients with locally advanced or metastatic ALK-positive NSCLC.