Montagnani Francesco, Di Leonardo Greta, Pino Mariasimona, Perboni Simona, Ribecco Angela, Fioretto Luisa
Oncology Department, Istituto Tumori Toscano (I.T.T.), Azienda Sanitaria di Firenze, Piazza Santa Maria Nuova 1, Florence 50122, Italy.
J Transl Int Med. 2017 Mar 31;5(1):18-26. doi: 10.1515/jtim-2017-0005. eCollection 2017 Mar.
Clinical data suggest that beyond-progression, the blockade of angiogenesis is associated with improved survivals in colorectal cancer. We conducted a systematic review to investigate the therapeutic effects of antiangiogenic drugs administered as later lines of treatment in patients already progressed to a previous anti-VEGF based treatment. An extensive literature search was conducted. Hazard ratios (HR) for progression (PFS) and death (OS) were extracted. An inverse-variance meta-analysis model was implemented. 6 randomized controlled trials were retrieved, including 3407 patients, treated with different antiangiogenic drugs. All of them had progressed during or after a previous line of treatment with bevacizumab. Overall, both PFS (HR=0.63, <0.001) and OS (HR=0.81, < 0.001) were significantly increased with the use of antiangiogenic drug. No heterogeneity was observed despite different drugs. Protracted inhibition of the VEGF pathway is associated with a significant improvement of both PFS and OS, independently from the antiangiogenic agent used.
临床数据表明，在疾病进展后，抑制血管生成与改善结直肠癌患者的生存率相关。我们进行了一项系统评价，以研究抗血管生成药物作为后续治疗方案，用于已进展至先前基于抗VEGF治疗的患者时的治疗效果。我们进行了广泛的文献检索。提取了疾病进展（无进展生存期，PFS）和死亡（总生存期，OS）的风险比（HR）。采用逆方差荟萃分析模型。检索到6项随机对照试验，包括3407例接受不同抗血管生成药物治疗的患者。所有患者均在先前使用贝伐单抗治疗期间或之后出现疾病进展。总体而言，使用抗血管生成药物可使PFS（HR = 0.63，<0.001）和OS（HR = 0.81，<0.001）均显著延长。尽管使用了不同的药物，但未观察到异质性。VEGF通路的长期抑制与PFS和OS的显著改善相关，与所使用的抗血管生成药物无关。
