Efficacy and safety of WBRT+EGFR‐TKI versus WBRT only in the treatment of NSCLC patients with brain metastasis: An updated meta‐analysis

BACKGROUND: To investigate the efficacy and safety of whole brain radiotherapy (WBRT) combined with epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) versus WBRT only in the treatment of brain metastasis in non‐small cell lung cancer (NSCLC) patients by pooling open published data. METHODS: Prospective clinical studies relevant to WBRT+EGFR‐TKI versus WBRT only in the treatment of NSCLC brain metastasis were electronically searched in the Pubmed, EMbase, Cochrane, Wangfang, CNKI and Google scholar databases. The treatment response, 1‐year survival and treatment‐associated toxicity were pooled and expressed by odds ratio (OR) under a fixed or random effect model. The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. RESULTS: Eighteen prospective clinical studies were included in the study. The combined results indicated that the objective response rate (ORR) in the WBRT+TKI group was superior to WBRT only with a statistical difference (OR = 2.67, 95% CI: 2.10–3.38, p < 0.05) under a fixed effect model. Ten studies reported the 1‐year survival rate between the WBRT+TKI and WBRT only groups. The combined results showed that 1‐year survival rate in the WBRT+TKI group was higher than that of the WBRT only group with a statistical difference (OR = 2.70, 95% CI: 1.95–3.74, p < 0.05). For treatment‐associated toxicity, the combined data indicated that the treatment‐related rash in the WBRT+TKI group was significantly higher than that of the WBRT only group with a statistical difference (OR = 2.72, 95% CI: 1.53–4.84, p < 0.05). However, the incidence of nausea/vomiting (OR = 0.84, 95% CI: 0.60–1.17, p > 0.05), diarrhea (OR = 1.31, 95% CI: 0.83–2.07, p > 0.05), fatigue (OR = 1.40, 95% CI: 0.70–2.81, p > 0.05) and myelosuppression (OR = 0.86, 95% CI: 0.56–1.32, p > 0.05) were not statistically different between the two groups. CONCLUSIONS: Based on the current publications, WBRT+EGFR‐TKI can improve the treatment response and 1‐year survival rate but not increase the toxicity except for rash compared to WBRT alone in the treatment of brain metastasis in NSCLC patients.