临床荟萃

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靶向药物治疗晚期胰腺癌的Meta分析

  

  1. 上海中医药大学附属普陀医院 上海市普陀区中心医院  药学部,上海  200062
  • 出版日期:2017-05-05 发布日期:2017-05-05
  • 通讯作者: 通信作者:李新燕,Email:lixinyanyan@126.com

Targeted agents for advanced pancreatic cancer: a  metaanalysis

  1. Department of Pharmacy, Puto Hospital affiliated to Shanghai University of 
    Traditional Chinese Medicine, Shanghai 200062, China
  • Online:2017-05-05 Published:2017-05-05
  • Contact: Corresponding author:Li Xinyan,Email:lixinyanyan@126.com

摘要: 目的评价靶向药物与吉西他滨联合用药治疗晚期胰腺癌患者的临床效果和安全性。方法检索中国期刊全文数据库、PubMed、Cochrane 图书馆和EMBASE数据库,所选的文献为Ⅲ期随机对照临床试验,关于靶向药物联合吉西他滨的化疗与吉西他滨单用的化疗做有效性和安全性的对比。提取纳入文献的总生存期、无进展生存期、客观缓解率、临床获益率和毒性反应率等资料。对入选研究做Meta分析,并且根据不同的靶向作用机制进行亚组分析查看研究的异质性。文章通过漏斗图和Egger检测法评价偏倚性。结果研究纳入了13篇文献,共6 664例受试者。在Meta分析中,两组总生存期(HR=0.984, 95%CI=0.930~1.041,P=0.567)、无进展生存期(HR=0.955,95%CI=0.898~1.015,P=0.137)和客观缓解率(OR=1.188,95%CI=0.978~1.442,P=0.082)差异未见有统计学意义。联合化疗组提高临床获益率(OR=1.249,95%CI=1.039~1.501,P=0.018)。联合化疗组增加了胰腺癌患者3~4级嗜中性白细胞减少症、腹泻和皮疹的不良反应。结论晚期胰腺癌患者接受靶向药物和吉西他滨联合化疗与吉西他滨单用相比,不能提高患者的总生存期和无进展生存期,需要进一步研究靶向药物对晚期胰腺癌的作用。

关键词: 胰腺肿瘤, 免疫毒素类, 抗肿瘤联合化疗方案, Meta分析

Abstract: ObjectiveTo assess whether targeted agents added to gemcitabine has benefit for advanced pancreatic cancer. MethodsBy searching CNKI, PubMed, Cochrane Library and EMBASE databases, data were retrieved from phase Ⅲ clinical randomized controlled trials to compare the efficacy and safety  between targeted therapy plus gemcitabine and gemcitabine alone for advanced pancreatic cancer. The primary endpoints included overall survival (OS), progressionfree survival (PFS), objective response rate (ORR), clinical benefit rate (CBR), and toxicity rate. ResultsThirteen randomized controlled trials involving a total of 6 664 patients were selected for metaanalysis. In the pooled analysis, no statistical difference was found on OS (HR=0.984,95%CI=0.9301.041,P=0.567), PFS   (HR=0.955,95%CI=0.8981.015,P=0.137) and ORR (OR=1.188,95%CI=0.9781.442,P=0.082) for targeted agents plus gemcitabine compared with gemcitabine alone.  Targeted agents demonstrated a significant increase on CBR  (OR=1.249,95%CI=1.0391.501,P=0.018). The side reactions of medicine, such as grade 34 neutropenia, diarrhoea and rash were significantly increased in targeted agents. ConclusionBased on the outcomes of this analysis, addition of targeted agents can not improve OS and PFS of patients.

Key words: pancreatic neoplasms, immunotoxins, antineoplastic combined chomotherapy protocols, metaanalysis