1467P - Meta-analysis evaluating neutropenia incidence with EGFR inhibitors and chemotherapy in patients with NSCLC

Neutropenia is widely documented in patients with cancer undergoing cytotoxic chemotherapy. However evidence is limited regarding the incidence of neutropenia with targeted treatments. Monoclonal antibody inhibitors of epidermal growth factor receptors (EGFR) have significantly improved progression-free survival in patients with non-small cell lung cancer (NSCLC), particularly those with EGFR mutations. There is some evidence of Grade 3/4 neutropenia with EGFR inhibitors; this meta-analysis aimed to compare the incidence of Grade 3/4 neutropenia with EGFR inhibitors and chemotherapy, in patients with NSCLC. A Medline literature search up to January 2019 identified randomized clinical trials (RCTs) that compared an EGFR inhibitor + chemotherapy, with chemotherapy (CT). The primary endpoint was incidence of Grade 3/4 neutropenia. A total of 10 eligible RCTs were included in this meta-analysis (n=6314). All studies compared an EGFR inhibitor (cetuximab [C+CT group, N=2217] or necitumumab [N+CT group, N=970]) + CT, with CT [CT group, N=3127]. Baseline characteristics were generally similar between groups, including age ≥65 years (C+CT, 30.1%; N+CT, 32.5%; CT, 32.0%), ECOG (0,1) (C+CT, 92.2%; N+CT, 93.2%; CT, 92.6%), sex (women: C+CT, 39.4%; N+CT, 22.6%; CT, 33.5%), and tumor stage (IIIb: C+CT, 13.7%; N+CT, N/A; CT, 9.9%; V: C+CT, 70.8%; N+CT, 100%; CT, 79.9%). A mixed effect model was considered, with the study effect considered to be random effect and treatment effect considered to be fixed effect. The probability of Grade 3/4 neutropenia was 26.4% in the C+CT arm, 28.6% in the N+CT arm, and 32.5% in the CT arm; not significantly different between groups. (Table).Table1467P Results of nonlinear mixed effect model with binary outcome of grade 3/4 NeutropeniaTableArmsEstimateStandard errorDFT valuePr > |t|AlphaLowerUpperMeanStandard error meanLower meanUpper meanCetuximab + chemotherapy-0.73220.28856-2.540.04420.05-1.4381-0.026260.32470.063260.19180.4934Necitumumab + chemotherapy-1.02350.29896-3.420.01410.05-1.7549-0.29210.26430.058130.14740.4275Chemotherapy-0.91560.28526-3.210.01830.05-1.6134-0.21780.28590.058220.16610.4458 In patients with NSCLC, the incidence of Grade 3/4 neutropenia with EGFR-targeted therapy in combination with chemotherapy, is not significantly different compared to chemotherapy. Caroline McGown of Spirit Medical Communications Ltd, supported by Hexal AG. Hexal AG. Hexal AG. B. Rapoport: Research grant / Funding (institution): Sandoz; Hon