Abstract
Apatinib has been widely applied for the treatment of gastrointestinal cancer since its development; however, available conclusive data regarding its use in non-small cell lung cancer (NSCLC) are lacking. Thus, the present meta-analysis aimed to compare the efficacy and safety of the use of apatinib plus chemotherapy vs. chemotherapy alone for the treatment of patients with advanced-stage NSCLC. Published studies reporting the treatment response, progression-free survival (PFS), overall survival (OS) and adverse events in patients with advanced-stage NSCLC treated with apatinib plus chemotherapy or chemotherapy alone were searched using the PubMed, China National Knowledge Infrastructure, EMBASE, Chongqing VIP Information, Cochrane and Wanfang databases until February 2023. Finally, 18 studies involving 677 patients with NSCLC receiving apatinib plus chemotherapy and 672 patients with NSCLC receiving chemotherapy were included in the present analysis. Apatinib plus chemotherapy was found to increase the objective response rate [relative risk (RR), 1.60; 95% confidence interval (CI), 1.38-1.86] and disease control rate (RR, 1.29; 95% CI, 1.21-1.38) compared to chemotherapy alone. Of note, apatinib plus chemotherapy also prolonged PFS compared with chemotherapy alone (hazard ratio, 0.54; 95% CI, 0.35-0.73), while no OS data were retrievable from the included studies. With regard to safety, apatinib plus chemotherapy elevated the risk of developing hypertension (RR, 3.78; 95% CI, 1.81-7.93) and hand-foot syndrome (RR, 6.51; 95% CI, 3.70-11.46) vs. chemotherapy alone; however, no difference was observed between the two regimens in terms of the incidence of other adverse events. Furthermore, the bias was low and the pooled findings were reliable/stable, as indicated by a sensitivity analysis. On the whole, the present study demonstrates that apatinib plus chemotherapy increases the treatment response and PFS vs. chemotherapy alone, while it also elevates the risk of developing hypertension and hand-foot syndrome in patients with advanced-stage NSCLC.