Zhu Ning, He Jian, Zhang Siwei, Chen Xiaodong
Department of Respiratory, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China.
Zhongguo Fei Ai Za Zhi. 2009 Aug 20;12(8):868-74. doi: 10.3779/j.issn.1009-3419.2009.08.07.
The platinum-based plus a third-generation agent doublet chemotherapy regimen has been recommended as the standard first-line chemotherapy for advanced NSCLC by ASCO and NCCN. This study was aimed to evaluate the clinical efficacy and side effects of the Platinum plus Taxanes or other novel agent.
The databases PubMed, CENTRAL, EMBASE and Chinese Biomedical Literature database were retrieved by using the key words "non small cell lung cancer" or "Carcinoma, Non Small Cell Lung" so as to search the studies about the randomized controlled clinical trials, which compared Platinum plus Taxanes with Platinum plus other novel agents. A meta-analysis was conducted and the quality scores were evaluated according to the improved Jadad's score.
Nine randomized controlled clinical trials with 4 703 patients were included. The overall response rate and 1 year survival rate of the two groups were not significantly different (RR=1.00, 95%CI: 0.91-1.11, P=0.95; RR=0.98, 95%CI: 0.84-1.15, P=0.83). The incidence rate of grade 3-4 leukopenia, neutropenia, anemia, nausea and vomiting in TP is much lower than that in platinum plus other novel agent. Sub-group analysis showed that the overall response rate and 1 year survival rate of TP aren't statistically different from NP or GP. The incidence rate of grade 3-4 leukopenia, neutropenia and anemia in TP is statistically lower than that in NP. The incidence rate of grade 3-4 anemia and thrombocytopenia in TP is statistically lower than that in GP.
The clinical efficacy of TP and platinum plus other novel agent is quite similar, but quite different from each other in side effects, which provides important evidence on selecting individual chemotherapy regimen.
铂类联合第三代药物的双联化疗方案已被美国临床肿瘤学会(ASCO)和美国国立综合癌症网络(NCCN)推荐为晚期非小细胞肺癌的标准一线化疗方案。本研究旨在评估铂类联合紫杉烷类或其他新型药物的临床疗效及副作用。
通过使用关键词“非小细胞肺癌”或“非小细胞肺癌癌”检索PubMed、CENTRAL、EMBASE和中国生物医学文献数据库,以查找比较铂类联合紫杉烷类与铂类联合其他新型药物的随机对照临床试验研究。进行荟萃分析,并根据改良的Jadad评分评估质量得分。
纳入9项随机对照临床试验,共4703例患者。两组的总缓解率和1年生存率无显著差异(RR = 1.00,95%CI:0.91 - 1.11,P = 0.95;RR = 0.98,95%CI:0.84 - 1.15,P = 0.83)。TP组3 - 4级白细胞减少、中性粒细胞减少、贫血、恶心和呕吐的发生率远低于铂类联合其他新型药物组。亚组分析显示,TP组的总缓解率和1年生存率与NP组或GP组无统计学差异。TP组3 - 4级白细胞减少、中性粒细胞减少和贫血的发生率低于NP组。TP组3 - 4级贫血和血小板减少的发生率低于GP组。
TP方案与铂类联合其他新型药物的临床疗效相当,但副作用差异较大,这为选择个体化化疗方案提供了重要依据。