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Background <p>Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the standard of care for advanced non-small cell lung cancer (NSCLC). However, their comparative efficacy and safety profile in early-stage versus advanced-stage disease remains systematically unexplored.</p> Methods <p>We performed a systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Web of Science through January 4, 2025. Included studies reported objective response rate (ORR), disease control rate (DCR), or treatment-related adverse events (TRAEs) for EGFR-TKI monotherapy. Pooled estimates were synthesized using a generalized linear mixed model (GLMM).</p> Results <p>Forty-two studies comprising 46 treatment groups and 3713 patients (343 early-stage; 3370 advanced-stage) were included. Efficacy: The pooled ORR was significantly higher in advanced-stage NSCLC (0.59, 95% CI 0.51–0.67) than in early-stage disease (0.36, 95% CI 0.15–0.63). In contrast, early-stage disease achieved a higher DCR (0.95 vs. 0.89). Safety: Early-stage patients experienced a significantly lower incidence of Grade ≥3 TRAEs compared to those with advanced disease (8.0% vs. 21%).</p> Conclusion <p>EGFR-TKIs provide superior tumor shrinkage (ORR) in advanced NSCLC, the reasons remain uncertain, whereas early-stage disease achieves better disease stability (DCR) with significantly enhanced tolerability. These findings suggest that stage-specific strategies—potentially combining TKIs with other modalities in early stages—are necessary to optimize clinical outcomes.</p>

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Comparison Between EGFR-TKI Efficacy in Early-Stage Non-small Cell Lung Cancer and Advanced Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Bingxue Wang,
  • Yang Yao,
  • Zhangxuan Chen,
  • Ranpu Wu,
  • Jiajie Sun,
  • Xinjing Li,
  • Xuanhao Xu,
  • Yunxiao Si,
  • Hongbing Liu

摘要

Background

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the standard of care for advanced non-small cell lung cancer (NSCLC). However, their comparative efficacy and safety profile in early-stage versus advanced-stage disease remains systematically unexplored.

Methods

We performed a systematic review and meta-analysis of PubMed, Embase, Cochrane Library, and Web of Science through January 4, 2025. Included studies reported objective response rate (ORR), disease control rate (DCR), or treatment-related adverse events (TRAEs) for EGFR-TKI monotherapy. Pooled estimates were synthesized using a generalized linear mixed model (GLMM).

Results

Forty-two studies comprising 46 treatment groups and 3713 patients (343 early-stage; 3370 advanced-stage) were included. Efficacy: The pooled ORR was significantly higher in advanced-stage NSCLC (0.59, 95% CI 0.51–0.67) than in early-stage disease (0.36, 95% CI 0.15–0.63). In contrast, early-stage disease achieved a higher DCR (0.95 vs. 0.89). Safety: Early-stage patients experienced a significantly lower incidence of Grade ≥3 TRAEs compared to those with advanced disease (8.0% vs. 21%).

Conclusion

EGFR-TKIs provide superior tumor shrinkage (ORR) in advanced NSCLC, the reasons remain uncertain, whereas early-stage disease achieves better disease stability (DCR) with significantly enhanced tolerability. These findings suggest that stage-specific strategies—potentially combining TKIs with other modalities in early stages—are necessary to optimize clinical outcomes.