Efficacy and safety of first-line EGFR-TKI combined with chemotherapy versus EGFR-TKI monotherapy in patients with EGFR-mutant non-small cell lung cancer and liver metastases: A propensity score–matched analysis

INTRODUCTION: Liver metastasis (LM) confers a poor prognosis in patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Although EGFR tyrosine kinase inhibitors (TKIs) are the standard first-line treatment, the optimal approach for this high-risk subgroup remains uncertain. This study compared the efficacy and safety of EGFR-TKI monotherapy versus EGFR-TKI combined with chemotherapy in EGFR-mutant NSCLC patients with LM. PATIENTS AND METHODS: We retrospectively analyzed 98 patients with stage IV EGFR-mutant NSCLC and LM treated between 2020 and 2025. Fifty-nine patients received EGFR-TKI monotherapy, and 39 received EGFR-TKI plus platinum-based chemotherapy. Propensity score matching (PSM) was performed to balance baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared by Cox regression. Safety profiles were analyzed according to CTCAE v5.0. RESULTS: After PSM, baseline characteristics were well balanced. The combination group achieved a higher objective response rate (59.0% vs 35.6%; P = .038), a higher disease control rate (100% vs 86.4%; P = .020), and a longer median PFS (14.0 vs 10.4 months; HR, 0.47; 95% CI, 0.26-0.86; P = .012). Median OS was 30.0 months with combination therapy versus 24.0 months with monotherapy (HR, 0.78; 95% CI, 0.39-1.55; P = .474). Severe (grade ≥3) adverse events were infrequent and comparable between groups, with no treatment-related deaths. CONCLUSION: First-line EGFR-TKI plus chemotherapy significantly improved PFS and disease control without added toxicity, suggesting a promising therapeutic strategy for EGFR-mutant NSCLC with LM.