{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:02Z","timestamp":1789711742411,"version":"4.0.1"},"reference-count":62,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction and aims<\/jats:title>\n                    <jats:p>Oral mucositis (OM) impairs quality of life, necessitates dose modification, and disrupts treatment continuity in patients receiving EGFR tyrosine kinase inhibitors (EGFR-TKIs), yet comparative OM risks across monotherapies and combination regimens remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception to June 13, 2026, for phase II or III randomized controlled trials. Bayesian random-effects network meta-analyses estimated odds ratios (ORs) with 95% credible intervals (CrIs) for any-grade and grade \u22653 OM. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-three trials involving 21,845 participants were included. Compared with chemotherapy, higher odds of any-grade OM were observed with afatinib plus cetuximab (OR 11.97, 95% CrI 2.27\u201365.45), afatinib (OR 9.73, 95% CrI 3.75\u201326.50), dacomitinib (OR 5.12, 95% CrI 1.71\u201316.00), and erlotinib plus chemotherapy (OR 2.84, 95% CrI 1.27\u20136.53), with low-, high-, moderate-, and very-low-certainty evidence, respectively; for grade \u22653 OM, with afatinib plus cetuximab (OR 13.91, 95% CrI 1.55\u2013199.26), afatinib (OR 8.80, 95% CrI 1.37\u2013100.11), and mobocertinib (OR 8.12, 95% CrI 1.14\u201397.77), all supported by moderate-certainty evidence. Afatinib plus cetuximab ranked highest for both outcomes (SUCRA, 89.0% and 91.6%). Second-generation EGFR-TKIs generally ranked higher, whereas the third-generation agents osimertinib and furmonertinib ranked lower. Combination regimens often yielded higher point\u00a0estimates than matched monotherapies, but most comparisons were inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>OM risk varies substantially across EGFR-TKI regimens. Higher-risk regimens warrant strengthened baseline oral assessment, patient education, and monitoring during treatment. Given limited head-to-head evidence for novel agents\/combinations and imprecision in some estimates, findings warrant further validation in standardized prospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261449930<\/jats:ext-link>\n                      , identifier CRD420261449930.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1957825","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:37:55Z","timestamp":1789709875000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral mucositis risk with EGFR tyrosine kinase inhibitor monotherapies and combination regimens in non-small cell lung cancer: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Huiwen","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, Zhejiang, China"]},{"name":"The First School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, Zhejiang, China"]},{"name":"The First School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, Zhejiang, China"]},{"name":"The First School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaochenxi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","place":["Hangzhou, Zhejiang, China"]},{"name":"The First School of Clinical Medicine, Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, 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