Epidermal growth factor receptor-
tyrosine kinase inhibitors (EGFR-TKIs) are a critical member of systemic
therapy for advanced
non-small-cell lung cancer (NSCLC).
Erlotinib is the first-generation EGFR-TKIs, the National Comprehensive
Cancer Network (NCCN) guidelines recommend it as a first-line agent in patients with sensitizing EGFR mutations. However, the safety of
erlotinib plus
chemotherapy (CT) or
erlotinib alone for advanced NSCLC remains controversial. We carried out a systematic meta-analysis to determine the overall risk of
neutropenia and
leukopenia associated with
erlotinib. PubMed, EMBASE, CBM, CNKI, WanFang database, The Cochrane library, Web of Science, as well as abstracts presented at ASCO conferences and ClinicalTrials.gov were searched to identify relevant studies. RR with 95% CIs for
neutropenia and
leukopenia were all extracted. The random-effects model was used to calculate pooled RRs and 95% CIs. Power calculation was performed using macro embedded in SAS software after all syntheses were conducted. We identified 12 eligible studies involving 3932 patients.
Erlotinib plus CT or alone relative to CT is associated with significantly decreased risks of
neutropenia and
leukopenia in patients with advanced NSCLC (RR, 0.38; 95% CI, 0.21-0.71; P = 0.00; incidence: 9.9 vs. 35.2%) and (RR, 0.32; 95% CI, 0.11-0.93; P = 0.04; incidence: 3.5 vs. 11.6%), respectively. The subgroup analysis by
erlotinib with or without CT showed that
erlotinib combine with CT have no significance decrease the relative risks of
neutropenia or
leukopenia (RR, 0.98; 95% CI, 0.78-1.23; P = 0.87; incidence: 26.2 vs. 30.5%) and (RR, 0.81; 95% CI, 0.34-1.95; P = 0.64; incidence: 6.5 vs. 9.3%), respectively. However,
erlotinib alone could decrease incidence of
neutropenia (RR, 0.14; 95% CI, 0.07-0.27; P = 0.00; incidence: 3.7 vs. 40.8%) or
leukopenia (RR, 0.07; 95% CI, 0.01-0.45; P = 0.01; incidence: 0.8 vs. 15.7%). The power analysis suggests that a power of 61.31% was determined to detect an RR of 0.38 for
neutropenia, and 78.03% for an RR of 0.32 for
leukopenia. The present meta-analysis suggested that
erlotinib could decrease the incidence of
neutropenia and
leukopenia in patients with advanced NSCLC undergoing
erlotinib regardless of whether combined with CT or not. The subgroup analysis revealed that
erlotinib combine with CT did not affect the incidence; however,
erlotinib alone could significantly decrease the incidence of
neutropenia and
leukopenia compared with CT alone.