Gibson Jean-Marie, Alzghari Saeed, Ahn Chul, Trantham Holly, La-Beck Ninh M
Department of Immunotherapeutics and Biotechnology, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas, USA;
Oncologist. 2013;18(9):1022-31. doi: 10.1634/theoncologist.2013-0126. Epub 2013 Jul 23.
Recent studies suggest that carboplatin with pegylated liposomal doxorubicin (C+PLD) is as efficacious as carboplatin with paclitaxel (C+P) and possibly is more tolerable for ovarian cancer therapy. Pegylated liposomal doxorubicin (PLD) may also be efficacious and tolerable as monotherapy in recurrent or platinum-resistant disease. We performed a meta-analysis of randomized trials in order to elucidate the role of PLD in ovarian cancer.
We searched PubMed, Scopus, and ISI Web of Knowledge for studies comparing C+PLD with C+P and comparing PLD with another monotherapy. Summary hazard ratios (HRs) and relative risks with their corresponding 95% confidence intervals (CIs) were calculated using a fixed-effects model.
Three trials were included in the doublet regimen analysis, and five trials were included in the monotherapy regimen analysis. C+PLD provided superior progression-free survival (PFS) (HR, 0.87; 95% CI, 0.78-0.96) and similar overall survival (OS; HR, 0.95; 95% CI, 0.84-1.07) compared with C+P. There was no evidence of improved tolerability: C+PLD had more gastrointestinal toxicity, anemia, thrombocytopenia, cutaneous toxicity, and mucositis/stomatitis, although there was less neutropenia, neuropathy, and alopecia. PLD monotherapy had similar PFS (HR, 0.99; 95% CI, 0.89-1.11) and OS (HR, 0.99; 95% CI, 0.88-1.11) to other monotherapies, but it was more tolerable. There was less neutropenia, anemia, thrombocytopenia, and gastrointestinal toxicity, although cutaneous toxicity was increased.
C+PLD had better PFS and similar OS compared with C+P and had a very different toxicity profile. Therapy selection could be based on patient risks for side effects. PLD is as efficacious as other monotherapies and is more tolerable.
近期研究表明，卡铂联合聚乙二醇脂质体阿霉素（C+PLD）与卡铂联合紫杉醇（C+P）疗效相当，且可能对卵巢癌治疗更具耐受性。聚乙二醇脂质体阿霉素（PLD）作为复发性或铂耐药性疾病的单一疗法也可能有效且耐受性良好。我们进行了一项随机试验的荟萃分析，以阐明PLD在卵巢癌中的作用。
我们在PubMed、Scopus和ISI Web of Knowledge中检索了比较C+PLD与C+P以及比较PLD与另一种单一疗法的研究。使用固定效应模型计算汇总风险比（HRs）及其相应的95%置信区间（CIs）。
双联方案分析纳入了3项试验，单一疗法方案分析纳入了5项试验。与C+P相比，C+PLD具有更好的无进展生存期（PFS）（HR，0.87；95%CI，0.78 - 0.96）和相似的总生存期（OS；HR，0.95；95%CI，0.84 - 1.07）。没有证据表明耐受性有所改善：C+PLD有更多的胃肠道毒性、贫血、血小板减少、皮肤毒性和粘膜炎/口腔炎，尽管中性粒细胞减少、神经病变和脱发较少。PLD单一疗法与其他单一疗法的PFS（HR，0.99；95%CI，0.89 - 1.11）和OS（HR，0.99；95%CI，0.88 - 1.11）相似，但耐受性更好。中性粒细胞减少、贫血、血小板减少和胃肠道毒性较少，尽管皮肤毒性增加。
与C+P相比，C+PLD具有更好的PFS和相似的OS，且毒性特征非常不同。治疗选择可基于患者的副作用风险。PLD与其他单一疗法疗效相当且耐受性更好。
