Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
PLoS One. 2012;7(5):e37229. doi: 10.1371/journal.pone.0037229. Epub 2012 May 17.
To compare the efficacy and toxicities of pemetrexed plus platinum with other platinum regimens in patients with previously untreated advanced non-small cell lung cancer (NSCLC).
A meta-analysis was performed using trials identified through PubMed, EMBASE, and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), and different types of toxicity. Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using RevMan software.
Four trials involving 2,518 patients with previously untreated advanced NSCLC met the inclusion criteria. Pemetrexed plus platinum chemotherapy (PPC) improved survival compared with other platinum-based regimens (PBR) in patients with advanced NSCLC (HR = 0.91, 95% CI: 0.83-1.00, p = 0.04), especially in those with non-squamous histology (HR = 0.87, 95% CI: 0.77-0.98, p = 0.02). No statistically significant improvement in either PFS or RR was found in PPC group as compared with PBR group (HR = 1.03, 95% CI: 0.94-1.13, p = 0.57; OR = 1.15, 95% CI: 0.95-1.39, p = 0.15, respectively). Compared with PBR, PPC led to less grade 3-4 neutropenia and leukopenia but more grade 3-4 nausea. However, hematological toxicity analysis revealed significant heterogeneities.
Our results suggest that PPC in the first-line setting leads to a significant survival advantage with acceptable toxicities for advanced NSCLC patients, especially those with non-squamous histology, as compared with other PRB. PPC could be considered as the first-line treatment option for advanced NSCLC patients, especially those with non-squamous histology.
比较培美曲塞联合铂类与其他铂类方案治疗未经治疗的晚期非小细胞肺癌（NSCLC）患者的疗效和毒性。
通过 PubMed、EMBASE 和 Cochrane 数据库进行荟萃分析。两位研究者独立评估试验质量并提取数据。结局包括总生存期（OS）、无进展生存期（PFS）、缓解率（RR）和不同类型的毒性。使用 RevMan 软件汇总总体生存率（HR）、优势比（OR）及其 95%置信区间（CI）。
四项涉及未经治疗的晚期 NSCLC 患者的 2518 例患者的试验符合纳入标准。与其他铂类方案（PBR）相比，培美曲塞联合铂类化疗（PPC）改善了晚期 NSCLC 患者的生存（HR=0.91，95%CI：0.83-1.00，p=0.04），尤其是非鳞状组织学患者（HR=0.87，95%CI：0.77-0.98，p=0.02）。与 PBR 组相比，PPC 组在 PFS 或 RR 方面均未显著改善（HR=1.03，95%CI：0.94-1.13，p=0.57；OR=1.15，95%CI：0.95-1.39，p=0.15）。与 PBR 相比，PPC 导致较少的 3-4 级中性粒细胞减少和白细胞减少，但更多的 3-4 级恶心。然而，血液学毒性分析显示存在显著的异质性。
我们的结果表明，与其他 PBR 相比，PPC 作为一线治疗方案可显著改善晚期 NSCLC 患者的生存，且毒性可接受，特别是非鳞状组织学患者。PPC 可作为晚期 NSCLC 患者，特别是非鳞状组织学患者的一线治疗选择。
