铂类与非铂类化疗作为不可切除的晚期胃腺癌一线治疗：一项荟萃分析。
Platinum-based versus non-platinum-based chemotherapy as first line treatment of inoperable, advanced gastric adenocarcinoma: a meta-analysis.
机构信息
Department of Medical Oncology and State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
出版信息
PLoS One. 2013 Jul 11;8(7):e68974. doi: 10.1371/journal.pone.0068974. Print 2013.
BACKGROUND
Although the platinum regimen is adopted widely nowadays in spite of the excessive side effects, there is still no international standard for palliative chemotherapy of advanced gastric cancer. This meta-analysis assessed the efficacy and tolerability of platinum versus non-platinum chemotherapy as first-line palliative treatment in patients with inoperable, advanced gastric cancer.
METHODS
Randomized phase II and III clinical trials on first-line palliative chemotherapy in inoperable, advanced gastric cancer were identified by electronic searches of PubMed, Embase, and the Cochrane Controlled Trial Register, and hand searches of relevant abstract books and reference lists. Response rates, overall survival, and toxicity were analyzed. Depending on whether new-generation agents (S-1, taxanes and irinotecan) were utilized, the non-platinum regimens were divided into two subgroup.
RESULTS
Compared to non-platinum regimens containing new-generation agents, the use of platinum-based regimens was associated with better response (risk ratio (RR) = 1.94, 95%CI[1.48, 2.55], p<0.001), an increase of overall survival (hazard ratio (HR) = 0.85, 95%CI[0.78, 0.92], p<0.001), a higher risk of hematological and non-hematological toxicity. No statistically significant increase in response (RR = 1.03, 95%CI [0.85, 1.24], p = 0.76) or overall survival (HR = 1.07, 95%CI [0.88, 1.30], p = 0.49) was found when platinum therapies were compared to new-generation agent based combination regimens. The toxicity of platinum-based regimens was significantly higher for hematologic toxicity, nausea and vomiting, and neurotoxicity, but not for diarrhea and toxic death rate.
CONCLUSION
New-generation agent based combination regimens achieved similar response rate and overall survival as platinum-based therapy that had generally higher side effects. S-1, taxanes and irinotecan seemed to be valid options for patients with inoperable, advanced gastric cancer as first-line chemotherapy.
背景
尽管铂类药物治疗方案存在过度副作用，但目前仍缺乏晚期胃癌姑息性化疗的国际标准，该方案仍被广泛应用。本研究旨在评估铂类药物与非铂类药物化疗方案作为不可切除的晚期胃癌一线姑息性治疗的疗效和耐受性。
方法
通过电子检索 PubMed、Embase 和 Cochrane 对照试验注册库，并手动检索相关摘要集和参考文献，确定不可切除的晚期胃癌一线姑息性化疗的随机 II 期和 III 期临床试验。分析反应率、总生存率和毒性。根据是否使用新一代药物（S-1、紫杉烷类和伊立替康），将非铂类药物治疗方案分为两组。
结果
与含有新一代药物的非铂类药物治疗方案相比，使用铂类药物治疗方案与更好的反应（风险比（RR）=1.94，95%置信区间[1.48, 2.55]，p<0.001）、总生存率提高（风险比（HR）=0.85，95%置信区间[0.78, 0.92]，p<0.001）、血液学和非血液学毒性风险增加相关。与基于新一代药物的联合治疗方案相比，铂类药物治疗方案在反应率（RR=1.03，95%置信区间[0.85, 1.24]，p=0.76）或总生存率（HR=1.07，95%置信区间[0.88, 1.30]，p=0.49）方面无统计学意义的增加。铂类药物治疗方案的血液学毒性、恶心呕吐和神经毒性显著高于新一代药物治疗方案，但腹泻和毒性死亡率无显著差异。
结论
基于新一代药物的联合治疗方案与铂类药物治疗方案具有相似的反应率和总生存率，但副作用更高。S-1、紫杉烷类和伊立替康似乎是不可切除的晚期胃癌患者一线化疗的有效选择。
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