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Efficacy and safety of erlotinib combined with bevacizumab in the treatment of non-small cell lung cancer: A systematic review and meta-analysis.

厄洛替尼联合贝伐单抗治疗非小细胞肺癌疗效和安全性的系统评价和meta分析 [j].

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000018771
  • 作者列表:"Zhou K","Zhao S","Guo W","Ding L
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Non-small cell lung cancer (NSCLC) has a poor prognosis despite conventional treatments of surgery, radiotherapy, and chemotherapy. Small-molecule tyrosine kinase inhibitors acting on epidermal growth factor receptor (EGFR) have shown high efficacy and low toxicity for NSCLC. In particular, combining erlotinib with the VEGF antibody bevacizumab has therapeutic value in NSCLC, but the drugs' separate effects as monotherapy and any adverse outcomes of combination therapy remain unclear. OBJECTIVES:To determine the efficacy and safety of erlotinib and bevacizumab for NSCLC, we conducted a meta-analysis and systematic review of randomized controlled trials. DATA SOURCES:PubMed, Embase, Web of Science, and Cochrane databases were searched using keywords and manual review. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS:We reviewed randomized controlled trials on the use of erlotinib combined with bevacizumab in adult patients with NSCLC, including data on outcome measures of overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events. STUDY APPRAISAL AND SYNTHESIS METHODS:After quality assessment, datasets were evaluated for heterogeneity. In the event of significant heterogeneity, a random-effects model was used to assess the overall outcome measures as a result of treatments. Subgroup analysis was conducted to evaluate the source of heterogeneity on PFS. RESULTS:Compared with erlotinib or bevacizumab alone, the combined treatment did not significantly prolong OS (95% confidence interval [CI] = 0.84-1.11; P = .62) or increase the ORR (95% CI = 0.91-1.20; P = .52), but significantly improved PFS (95% CI = 0.58-0.73; P < .001). This improvement was especially notable in patients with the following characteristics: Eastern Cooperative Oncology Group Performance Status score of 0 or 1, female, no smoking history, adenocarcinoma, and EGFR Exon19 deletion or Exon21 Leu858Arg mutation. Combination therapy significantly increased incidence of grade 1-2 hypertension (20.3% vs 6.3%, 95% CI 1.73-5.88; P < .01) and severe diarrhea (10% vs 3.2%, 95% CI 1.36-6.60; P = .01). LIMITATIONS:The low number of available randomized controlled trials could influence interpretation. CONCLUSIONS:Compared with erlotinib or bevacizumab monotherapy, their combination effectively prolongs PFS but increases incidence of adverse events in NSCLC patients.

摘要

背景: 非小细胞肺癌 (NSCLC) 尽管有手术、放疗和化疗等常规治疗,但预后较差。作用于表皮生长因子受体 (EGFR) 的小分子酪氨酸激酶抑制剂已显示出对NSCLC的高效和低毒性。特别是,厄洛替尼联合VEGF抗体贝伐单抗在NSCLC中具有治疗价值,但这些药物作为单一疗法的单独作用和联合疗法的任何不良结局仍不清楚。 目的: 为了确定厄洛替尼和贝伐单抗治疗非小细胞肺癌的有效性和安全性,我们对随机对照试验进行了荟萃分析和系统评价。 数据来源: PubMed、Embase、Web of Science和Cochrane数据库使用关键词和人工审查进行搜索。 研究纳入标准、参与者和干预措施: 我们回顾了在成年NSCLC患者中使用厄洛替尼联合贝伐单抗的随机对照试验,包括总生存期 (OS) 结局指标的数据,无进展生存期 (PFS) 、客观缓解率 (ORR) 和不良事件。 研究评估和合成方法: 在质量评估之后,评估数据集的异质性。在存在显著异质性的情况下,使用随机效应模型来评估作为治疗结果的总体结果指标。进行亚组分析以评估PFS的异质性来源。 结果: 与单独使用厄洛替尼或贝伐单抗相比,联合治疗未显著延长OS (95% 可信区间 [CI]  =   0.84-1.11; P   =  .62) 或增加ORR (95% ci = 0.91-1.20; P =.52),但显著改善PFS (95% ci = 0.58-0.73; P <.001)。这种改善在具有以下特征的患者中尤其显著: 东部肿瘤协作组表现状态评分为 0 或 1,女性,无吸烟史,腺癌,和EGFR Exon19 缺失或Exon21 Leu858Arg突变。联合治疗显著增加 1-2 级高血压 (20.3% vs 6.3%,95% CI 1.73-5.88; P <.01) 和严重腹泻 (10% vs 3.2%,95% CI 1.36-6.60; P   =  .01)。 局限性: 可用的随机对照试验数量少可能影响解释。 结论: 与厄洛替尼或贝伐单抗单药治疗相比,联合用药可有效延长NSCLC患者的PFS,但增加不良事件的发生率。

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影响因子:6.93
发表时间:2020-01-15
DOI:10.1002/ijc.32532
作者列表:["Hata A","Nakajima T","Matsusaka K","Fukuyo M","Morimoto J","Yamamoto T","Sakairi Y","Rahmutulla B","Ota S","Wada H","Suzuki H","Matsubara H","Yoshino I","Kaneda A"]

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影响因子:6.93
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DOI:10.1002/ijc.32530
作者列表:["Zhang L","Yang Y","Chai L","Bu H","Yang Y","Huang H","Ran J","Zhu Y","Li L","Chen F","Li W"]

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肺肿瘤方向

肺肿瘤,又叫支气管肺癌,是常见的恶性肿瘤之一。肺肿瘤的治疗为包括手术、中药、放疗、化疗及免疫等多学科的综合治疗。

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