ALK-양성 비소세포성 폐암 환자 대상 Alectinib과 Crizotinib의 무진행 생존기간 효능 비교: 체계적 문헌 고찰 및 메타분석

Comparative Efficacy of Alectinib Versus Crizotinib in Progression-Free Survival Among Patients with ALK-Positive NSCLC (Non-Small Cell Lung Cancer): A Systematic Review and Meta-analysis

Abstract—BACKGROUNDS This study aimed to compare the efficacy of alectinib (Product name: Alecensa？？) and crizotinib (Product name: Xalkori？？) on progression-free survival (PFS) results in untreated anaplastic lymphoma kinase-positive non-small cell lung cancer (ALK-positive NSCLC) patients. METHODS We systematically searched for relevant literature in three electronic databases: PubMed, EMBASE, and Cochrane in April 2021. According to predefined selection criteria, two independent researchers screened studies and extracted data. The quality of the studies included was assessed using the Cochrane Risk of Bias tool. For the meta-analysis, the fixed-effect model and generic inverse-variance estimation method were utilized. The pooled hazard ratio (HR) of PFS was calculated to evaluate the efficacy of alectinib and crizotinib. Subgroup analysis for the Asian population was performed. I2 was calculated to assess the heterogeneity of studies. RESULTS Three studies on different clinical trials (ALEX, J-ALEX, and Alesia) were included for quantitative synthesis. The pooled HR of 0.42 (95% confidence intervals (CI), 0.34-0.53) indicated that the alectinib therapy proved significantly longer PFS than crizotinib therapy without heterogeneity (I2 = 0%). In the subgroup analysis for the Asian population, HR was 0.39 (95% CI, 0.31-0.50, I2 = 0%). CONCLUSION This study confirmed that alectinib showed superior PFS results over crizotinib, suggesting that prescribing alectinib to the ALK-positive NSCLC patients is an appropriate treatment option.