Canil Christina, Hotte Sebastien, Mayhew Linda A, Waldron Tricia S, Winquist Eric
The Ottawa Hospital Regional Cancer Centre, Ottawa, ON;
Can Urol Assoc J. 2010 Jun;4(3):201-8. doi: 10.5489/cuaj.853.
A systematic review was undertaken to determine whether interferon-alfa (IFN-alpha) is an effective treatment for patients with inoperable locally advanced or metastatic renal cell carcinoma (mRCC). MEDLINE, EMBASE, the Cochrane Library, guideline databases and relevant meeting proceedings were searched. Randomized clinical trials (RCTs) or meta-analyses comparing IFN-alpha-containing regimens to placebo or non-immunotherapy controls, and that reported response rate, survival, toxicity or quality of life data were eligible. Two systematic reviews and eight RCTs met the selection criteria. A Cochrane review updated in 2005 reported higher response rates and reduced one-year mortality based on 4 RCTs in patients who received IFN-alpha. Of the eight RCTs, three reporting objective response rate showed significant differences favouring IFN-alpha. Two of five trials reporting survival data showed longer median survival in the IFN-alpha group. Adverse effects of IFN-alpha were consistent across the trials with increased intensity and frequency concordant with increased IFN-alpha dose. Meta-analyses of seven RCTs for objective response and six RCTs for mortality favoured IFN-alpha: odds ratio 6.87 (95% Confidence Interval [CI], 3.29 to 14.35) and hazard ratio 0.79 (95% CI, 0.69 to 0.91), respectively. The effectiveness of IFN-alpha in mRCC has been subject to skepticism. As IFN-alpha has been used as a control arm in RCTs of new targeted therapies, therapies which not all patients may have access to, information about its effectiveness remains relevant. These data confirm genuine, if modest, effectiveness of IFN-alpha in mRCC.
进行了一项系统评价，以确定α干扰素（IFN-α）是否是治疗无法手术的局部晚期或转移性肾细胞癌（mRCC）患者的有效疗法。检索了MEDLINE、EMBASE、Cochrane图书馆、指南数据库及相关会议论文集。纳入比较含IFN-α方案与安慰剂或非免疫疗法对照的随机临床试验（RCT）或荟萃分析，且这些研究报告了缓解率、生存率、毒性或生活质量数据。两项系统评价和八项RCT符合纳入标准。2005年更新的一项Cochrane评价报告称，基于4项接受IFN-α治疗患者的RCT，其缓解率更高且一年死亡率降低。在八项RCT中，三项报告客观缓解率的研究显示，IFN-α组有显著差异。五项报告生存数据的试验中有两项显示，IFN-α组的中位生存期更长。IFN-α的不良反应在各试验中一致，其强度和频率随IFN-α剂量增加而增加。七项RCT的客观缓解率荟萃分析和六项RCT的死亡率荟萃分析均支持IFN-α：优势比分别为6.87（95%置信区间[CI]，3.29至14.35）和风险比0.79（95%CI，0.69至0.91）。IFN-α在mRCC中的有效性一直受到质疑。由于IFN-α在新靶向疗法的RCT中用作对照臂，而并非所有患者都能使用这些疗法，因此关于其有效性的信息仍然相关。这些数据证实了IFN-α在mRCC中确实具有一定有效性，尽管效果有限。
