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Background  The correlation between epidermal growth factor receptor‐tyrosine kinase inhibitors  (EGFR ‐ TKIs)  and  EGFR  sensitive mutation subtypes in advanced or metastatic non‐small cell lung cancer ( NSCLC)  remains uncertain. We performed this meta‐analysis to determine different clinical outcomes between patients with exon 19 deletion accepting  EGFR ‐ TKI  therapy compared with those with exon 21  L858R  mutation.    Methods  PubMed and Web of Science were analyzed for eligible trials. Raw data were extracted to give pooled estimates of the effect of  EGFR ‐ TKI  therapy on objective response rate ( ORR ), one‐year progression‐free survival ( PFS ), and two‐year overall survival ( OS ).    Results  We identified 13 eligible trials involving 912 patients. Prospective meta‐analysis demonstrated that the  ORR  of the 19 deletion group was significantly higher than the 21 L858R mutation group (odds ratio [ OR ] 1.98, 95% confidence interval [ CI]  1.18–3.33;  P  = 0.01), but no statistical significance between the one‐year  PFS  rate of the 19 deletion and 21 L858R groups ( OR  1.44, 95%  CI  0.96–2.18;  P  = 0.08) was found. However, retrospective meta‐analysis demonstrated that a significantly higher one‐year  PFS  rate was associated with the 19 deletion group ( OR  1.73, 95%  CI  1.17–2.56;  P  = 0.006). The two‐year survival rate of the 19 deletion group was significantly higher than the 21 L858R group ( OR  5.27, 95 %  CI  1.76–15.71;  P  = 0.003).    Conclusions  In advanced  NSCLC  patients, an exon 19 deleton may provide superior  ORR ,  PFS,  and  OS  after  EGFR ‐ TKI  treatment compared with an exon 21 L858R mutation.

thoracic cancer

Epidermal growth factor receptor‐tyrosine kinase inhibitor therapy is especially beneficial to patients with exon 19 deletion compared with exon 21  L858R  mutation in non‐small‐cell lung cancer: Systematic review and meta analysis