Necitumumab plus platinum-based chemotherapy versus chemotherapy alone as first-line treatment for stage IV non-small cell lung cancer: a meta-analysis based on randomized controlled trials

Background: Whether necitumumab combined with platinum-based chemotherapy (NC) for treating stage IV non-small cell lung cancer (NSCLC) as a first-line treatment could enhance antitumor effectiveness compared with platinum-based chemotherapy alone (CA) treatment is still controversial. The antitumor effectiveness and toxicity of the two treatments were compared in this meta-analysis. Methods: We searched in PubMed, ScienceDirect, Scopus, Web of Science, Ovid MEDLINE, the Cochrane Library, Embase, and Google Scholar to acquire applicable articles. The outcome indicators mainly included progression-free survival (PFS), overall survival (OS) and adverse effects (AEs). Results: Eight articles based on 4 randomized controlled trials were obtained. The NC group had a longer PFS [95% confidence interval (CI): 0.84-0.99, P=0.03] and a higher disease control rate (DCR, 95% CI: 1.01-1.10, P=0.03) than those of the CA group. OS (95% CI: 0.85-1.01, P=0.09) and the objective response rate (ORR, 95% CI: 0.93-1.71, P=0.14) were similar in the NC and CA groups. Nevertheless, in both quantity and extent, the NC treatment had more severe skin rash, hypomagnesemia, and venous thromboembolism than those of the CA treatment. Subanalysis suggested that the advantage of OS was more obvious in the NC group than that in the CA group in patients with high epidermal growth factor receptor (EGFR) expression. Conclusions: With a longer PFS and a higher DCR, NC treatment seemed to be more suitable for treating stage IV NSCLC as first-line therapy, especially for those with high EGFR expression, but its AEs could not be ignored.