Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No 1665, Kongjiang Road, Yangpu District, Shanghai 200092, PR China.
Pancreatology. 2013 Jul-Aug;13(4):415-22. doi: 10.1016/j.pan.2013.04.195. Epub 2013 Apr 28.
Several clinical trials have been published on gemcitabine-based chemotherapy with or without addition of agents against epidermal growth factor receptor (EGFR) or vascular endothelium growth factor receptor (VEGFR) in patients with advanced pancreatic cancer, however, with diverse results. The objective of this study was to perform a meta-analysis of the published trials.
The database of CENTRAL, MEDLINE and EMBASE were searched. Eligible studies were randomized clinical trials (RCTs) that evaluated the efficacy and safety profile of adding targeted agents against EGFR or VEGFR to gemcitabine-based chemotherapy in patients with advanced pancreatic cancer. The primary outcome was overall survival (OS) while secondary outcomes included progression free survival (PFS) and overall response rate (ORR). Toxicity profiles were also assessed. Review Manager 5.1 was used to perform the analysis.
Results reported from 6 RCTs involving 2733 patients were included in the analysis. Compared to gemcitabine-based chemotherapy alone, addition of an agent against EGFR resulted in significant longer OS [Hazard ratios (HR) 0.89 (0.79-0.99), p = 0.04] and longer PFS [HR 0.87 (0.79-0.97), p = 0.01], but no significant difference in ORR [RR 1.18 (0.82-1.70), p = 0.36]. The addition of an agent against VEGFR resulted in higher ORR [RR 1.54 (1.03-2.30), p = 0.04], but no advantage in OS [HR 0.95 (0.83-1.09), p = 0.47] or PFS [HR 0.97 (0.77-1.23), p = 0.82].
Addition of an agent against EGFR to gemcitabine-based chemotherapy improved OS compared to gemcitabine-based chemotherapy alone in patients with advanced pancreatic cancer, while addition of an agent against VEGFR showed a modest improvement in ORR but not PFS and OS.
几项关于吉西他滨为基础的化疗联合或不联合表皮生长因子受体（EGFR）或血管内皮生长因子受体（VEGFR）拮抗剂治疗晚期胰腺癌的临床试验已经发表，但结果各不相同。本研究的目的是对已发表的试验进行荟萃分析。
检索 CENTRAL、MEDLINE 和 EMBASE 数据库。纳入评估吉西他滨为基础的化疗联合 EGFR 或 VEGFR 靶向药物治疗晚期胰腺癌的疗效和安全性的随机临床试验（RCTs）。主要结局为总生存期（OS），次要结局包括无进展生存期（PFS）和总缓解率（ORR）。还评估了毒性谱。使用 Review Manager 5.1 进行分析。
纳入的 6 项 RCT 共 2733 例患者的结果报告被纳入分析。与吉西他滨为基础的化疗相比，联合 EGFR 拮抗剂可显著延长 OS [风险比（HR）0.89（0.79-0.99），p = 0.04]和 PFS [HR 0.87（0.79-0.97），p = 0.01]，但 ORR 无显著差异[RR 1.18（0.82-1.70），p = 0.36]。联合 VEGFR 拮抗剂可提高 ORR [RR 1.54（1.03-2.30），p = 0.04]，但 OS [HR 0.95（0.83-1.09），p = 0.47]和 PFS [HR 0.97（0.77-1.23），p = 0.82]无显著获益。
与吉西他滨为基础的化疗相比，吉西他滨为基础的化疗联合 EGFR 拮抗剂可改善晚期胰腺癌患者的 OS，而联合 VEGFR 拮抗剂可适度改善 ORR，但对 PFS 和 OS 无改善。
