University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Room 3051, Madison, WI 53705-2275, USA.
Cancer Treat Rev. 2012 Oct;38(6):613-7. doi: 10.1016/j.ctrv.2011.10.008. Epub 2011 Dec 10.
Paclitaxel is commonly given as a 3-h infusion every 3 weeks for a variety of malignancies. Several randomized clinical trials comparing weekly paclitaxel with Q3-week (Q3W) have produced mixed results in terms of efficacy and toxicity creating controversy about the ideal dose and schedule.
A literature search using PubMed, Cochrane Library, and Proceedings of the American Society of Clinical oncology from 1995 to 2011 was performed. We included all published and registered RTCs for advanced solid tumors which compared weekly paclitaxel with Q3W. Primary dependent variables--grade 3, 4 neutropenia rates and grade 3 sensory neuropathy rates--were analyzed for all cancer types. Secondary dependent variables--hazard ratios for survival and response rates--were analyzed for each cancer type. Moderators of cancer types, ethnicity, and paclitaxel dose ratio were analyzed for primary dependent variables.
Ten trials were included. The summary effects of the meta-analysis revealed less grade 3, 4 neutropenia (odds ratio: 0.49, p=0.0023) and a trend towards less grade 3 sensory neuropathy (odds ratio: 0.54, p=0.092) with weekly paclitaxel compared with Q3W. Moderator analysis by meta-regression revealed that paclitaxel dose ratios have a significantly positive correlation with rates of G3/4 neutropenia and sensory neuropathy. In the five NSCLC (non small cell lung cancer) trials, the summary effect revealed a better response rate with weekly paclitaxel (odds ratio: 1.24, p=0.042).
Weekly paclitaxel has a favorable toxicity profile compared to the current standard of Q3W paclitaxel.
紫杉醇通常以每 3 周 3 小时输注的方式用于多种恶性肿瘤。几项比较每周紫杉醇与 Q3 周（Q3W）的随机临床试验在疗效和毒性方面产生了混合结果，这引发了关于理想剂量和方案的争议。
使用 PubMed、Cochrane 图书馆和美国临床肿瘤学会会议记录从 1995 年到 2011 年进行了文献检索。我们纳入了所有比较晚期实体瘤中每周紫杉醇与 Q3W 的已发表和注册的 RCT。主要依赖变量 - 3 级、4 级中性粒细胞减少率和 3 级感觉神经病变率 - 用于所有癌症类型进行分析。次要依赖变量 - 生存和反应率的危险比 - 用于每种癌症类型进行分析。对癌症类型、种族和紫杉醇剂量比进行了分析，以确定主要依赖变量的调节剂。
纳入了 10 项试验。荟萃分析的综合效应表明，每周紫杉醇组 3 级、4 级中性粒细胞减少症（比值比：0.49，p=0.0023）和 3 级感觉神经病变（比值比：0.54，p=0.092）的发生率较低。Meta 回归的调节分析显示，紫杉醇剂量比与 G3/4 中性粒细胞减少症和感觉神经病变的发生率呈显著正相关。在 5 项 NSCLC（非小细胞肺癌）试验中，综合效应显示每周紫杉醇组的反应率更好（比值比：1.24，p=0.042）。
与目前的 Q3W 紫杉醇标准相比，每周紫杉醇具有更好的毒性特征。
