文章摘要

多靶点酪氨酸激酶抑制剂联合厄洛替尼治疗晚期非小细胞肺癌疗效和安全性的Meta分析

作者: 1姜 晓洁, 1史 尚雨宸, 1辛 勇
1 徐州医科大学附属医院肿瘤放疗科,江苏 徐州 221000
通讯: 辛 勇 Email: deep369@163.com
DOI: 10.3978/j.issn.2095-6959.2020.04.017
基金: 江苏省普通高校研究生科研、实践创新计划项目(SJCX18-0705)。

摘要

目的:系统评价多靶点酪氨酸激酶抑制剂联合厄洛替尼对比厄洛替尼单药治疗晚期非小细胞肺癌的疗效及安全性。方法:通过检索PubMed,Cochrane library,Web of Science,EMBASE,万方数据库,中国知网数据库和维普期刊全文数据库,收集关于多靶点酪氨酸激酶抑制剂联合厄洛替尼治疗晚期非小细胞肺癌的随机对照试验。对符合纳入标准的随机对照实验进行Meta分析,采用RevMan5.3软件进行数据处理。结果:共纳入5项随机对照研究,总计1 523名患者。Meta分析表明:与厄洛替尼单药治疗相比,多靶点酪氨酸激酶抑制剂联合厄洛替尼对非小细胞肺癌患者总生存期(overall survival,OS;HR=0.86,95%CI:0.69~1.07,P>0.05)的改善差异无统计学意义,但无进展生存期(progression-free survival,PFS;HR=0.68,95%CI:0.52~0.90,P<0.05)和客观缓解率(objective response rate,ORR;RR=1.46,95%CI:1.02~2.08,P<0.05)的差异有统计学意义。联合组腹泻、皮疹、乏力、厌食、恶心呕吐和血小板减少症III,IV级不良反应的发生率高于单药组,差异有统计学意义(P<0.05);贫血、血栓、脱水、高血压和黏膜炎症III,IV级不良反应的发生率差异无统计学意义(P>0.05)。结论:与厄洛替尼单药治疗相比,多靶点酪氨酸激酶抑制剂联合厄洛替尼治疗晚期非小细胞肺癌可以提高PFS和ORR,且不良反应可耐受。但该结论需要更多的大型临床试验进一步证实。
关键词: 非小细胞肺癌;酪氨酸激酶抑制剂;靶向治疗;Meta分析

Efficacy and safety of multi-targeted tyrosine kinase inhibitor combined with erlotinib for advanced NSCLC: A Meta-analysis

Authors: 1JIANG Xiaojie, 1SHI Shangyuchen, 1XIN Yong
1 Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu 221000, China

CorrespondingAuthor:XIN Yong Email: deep369@163.com

Foundation: This work was supported by the Project of Scientific Research and Practical Innovation Plan for Postgraduates in Jiangsu Province, China (SJCX18-0705).

Abstract

Objective: To evaluate the efficacy and safety of multi-targeted tyrosine kinase inhibitor combined with erlotinib for advanced non-small lung cancer cell (NSCLC). Methods: The PubMed, Cochrane library, Web of Science, EMBASE, Wanfang database, CNKI and VIP were searched to identify randomized controlled trials about multi-targeted tyrosine kinase inhibitor combined with erlotinib for advanced NSCLC. The RCTs that conformed to the inclusion criteria were performed Meta-analysis via RevMan5.3 software. Results: Five trials with a total of 1 523 patients were included in this study. Meta-analysis suggested that the combination of erlotinib and multi-targeted tyrosine kinase inhibitor did not improve overall survival (OS) (HR=0.86, 95% CI: 0.69–1.07, P>0.05), but improved progression-free survival (PFS) (HR=0.68, 95% CI: 0.52–0.90, P<0.05), and objective response rate (ORR) (RR=1.46, 95% CI: 1.02–2.08, P<0.05). The incidences of grade 3/4 adverse events such as diarrhea, rash, asthenia/fatigue, anorexia, nausea/vomiting and thrombocytopenia (P<0.05) were higher in the combination group than those in the monotherapy group. For anemia, thromboembolic event, dehydration, hypertension and mucosal inflammation (P>0.05), overall analysis did not demonstrate a difference. Conclusion: The combination of multi-targeted tyrosine kinase inhibitor plus erlotinib is superior to erlotinib alone in terms of PFS and ORR in treatment of advanced NSCLC with an acceptable and manageable risk of toxicity. However, more large-scale trials are needed to prove these findings.
Keywords: non-small cell lung cancer; tyrosine kinase inhibitor; targeted therapy; meta-analysis