Li Mei, Song Xiangqi, Zhu Jun, Fu Aijun, Li Jianmin, Chen Tong
Department of Neurosurgery, North China University of Science and Technology Affiliated Hospital, Tangshan 063000, Hebei Province, China.
Department of Neurosurgery, People's Hospital of Suning County, Cangzhou 062350, Hebei Province, China.
Clin Neurol Neurosurg. 2017 Aug;159:6-12. doi: 10.1016/j.clineuro.2017.05.015. Epub 2017 May 11.
New therapeutic agents in combination with the standard Stupp protocol (a protocol about the temozolomide combined with radiotherapy treatment with glioblastoma was research by Stupp R in 2005) were assessed to evaluate whether they were superior to the Stupp protocol alone, to determine the optimum treatment regimen for patients with newly diagnosed glioblastoma.
We implemented a search strategy to identify studies in the following databases: PubMed, Cochrane Library, EMBASE, CNKI, CBM, Wanfang, and VIP, and assessed the quality of extracted data from the trials included. Statistical software was used to perform network meta-analysis.
The use of novel therapeutic agents in combination with the Stupp protocol were all shown to be superior than the Stupp protocol alone for the treatment of newly diagnosed glioblastoma, ranked as follows: cilengitide 2000mg/5/week, bevacizumab in combination with irinotecan, nimotuzumab, bevacizumab, cilengitide 2000mg/2/week, cytokine-induced killer cell immunotherapy, and the Stupp protocol. In terms of serious adverse effects, the intervention group showed a 29% increase in the incidence of adverse events compared with the control group (patients treated only with Stupp protocol) with a statistically significant difference (RR=1.29; 95%CI 1.17-1.43; P<0.001). The most common adverse events were thrombocytopenia, lymphopenia, neutropenia, pneumonia, nausea, and vomiting, none of which were significantly different between the groups except for neutropenia, pneumonia, and embolism.
All intervention drugs evaluated in our study were superior to the Stupp protocol alone when used in combination with it. However, we could not conclusively confirm whether cilengitide 2000mg/5/week was the optimum regime, as only one trial using this protocol was included in our study.
评估新型治疗药物与标准的施图普方案（施图普·R于2005年开展了一项关于替莫唑胺联合放射治疗胶质母细胞瘤的方案研究）联合使用时是否优于单独使用施图普方案，以确定新诊断胶质母细胞瘤患者的最佳治疗方案。
我们实施了一项检索策略，以在以下数据库中识别研究：PubMed、考克兰图书馆、EMBASE、中国知网、中国生物医学文献数据库、万方数据库和维普资讯，评估纳入试验中提取数据的质量。使用统计软件进行网状Meta分析。
新型治疗药物与施图普方案联合使用时，在治疗新诊断的胶质母细胞瘤方面均显示优于单独使用施图普方案，排名如下：西仑吉肽2000mg/每周5次、贝伐单抗联合伊立替康、尼妥珠单抗、贝伐单抗、西仑吉肽2000mg/每周2次、细胞因子诱导的杀伤细胞免疫疗法以及施图普方案。在严重不良反应方面，干预组与对照组（仅接受施图普方案治疗的患者）相比，不良事件发生率增加了29%，差异具有统计学意义（RR = 1.29；95%CI 1.17 - 1.43；P < 0.001）。最常见的不良事件是血小板减少、淋巴细胞减少、中性粒细胞减少、肺炎、恶心和呕吐，除中性粒细胞减少、肺炎和栓塞外，各组之间这些不良事件均无显著差异。
我们研究中评估的所有干预药物与施图普方案联合使用时均优于单独使用施图普方案。然而，我们无法最终确定西仑吉肽2000mg/每周5次是否为最佳方案，因为我们的研究仅纳入了一项使用该方案的试验。
