Efficacy and Safety of Pemetrexed and Gefitinib in the Treatment of Non-Small-Cell Lung Cancer: A Meta-Analysis

Object. This study is aimed at evaluating the efficacy and safety of pemetrexed and gefitinib in the treatment of non-small-cell lung cancer (NSCLC). Methods. Databases, including PubMed, the Cochrane Library, Embase, CNKI, and Web of Science, were applied to search for randomized controlled trials (RCTs) about the use of pemetrexed and gefitinib in the second-line treatment of locally advanced and metastatic NSCLC from database foundation to April 2020. Meta-analysis was conducted using the RevMan 5.3 software. Primary outcomes included progression-free survival (PFS) and overall survival (OS), and secondary outcomes included objective response rate (ORR), disease control rate (DCR), and all grades of drug-related adverse events (AEs). Results. Totally, 14 RCTs and 1,334 patients were involved in the study. The results of meta-analysis showed that compared with pemetrexed, gefitinib was not superior in improving ORR ( P = 0.21 ), DCR ( P = 0.52 ), PFS ( P = 0.41 ), and OS ( P = 0.79 ). Subgroup analysis showed that in patients with mutant EGFR ( P = 0.08 ) and wild-type EGFR ( P = 0.80 ), both pemetrexed and gefitinib produced a similar effect on PFS. In terms of safety, the incidence of rash ( P < 0.00001 ) and diarrhea ( P = 0.0005 ) in the gefitinib group was significantly higher than those in the pemetrexed group, while the occurrence of neutropenia ( P = 0.01 ) and fatigue ( P = 0.02 ) was significantly lower. Conclusion. Gefitinib and pemetrexed showed similar efficacy and safety, regardless of the type of EGFR. Both gefitinib and pemetrexed can be used as conventional drugs for the second-line treatment of locally advanced and metastatic NSCLC.