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在中度致吐性化疗中添加神经激肽-1受体拮抗剂是否有益?一项系统评价和荟萃分析。

Is the addition of a neurokinin-1 receptor antagonist beneficial in moderately emetogenic chemotherapy?-a systematic review and meta-analysis.

作者信息

Jordan Karin, Blättermann Luisa, Hinke Axel, Müller-Tidow Carsten, Jahn Franziska

机构信息

Department of Medicine V, Hematology/ Oncology/ Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.

Department of Internal Medicine IV, Hematology/Oncology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle, Germany.

出版信息

Support Care Cancer. 2018 Jan;26(1):21-32. doi: 10.1007/s00520-017-3857-7. Epub 2017 Aug 31.

Abstract

PURPOSE

This systematic review evaluates the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of chemotherapy-induced nausea and vomiting (CINV) in moderately emetogenic chemotherapy (MEC) excluding anthracycline-cyclophosphamide-based regimens.

METHODS

A systematic review of MEDLINE (via PubMed and OVID) and Central databases, plus major oncology conferences, identified randomized trials evaluating NK1RAs in combination with a 5-HT RA plus a glucocorticoid for management of CINV. Efficacy endpoints were complete response (CR), no emesis and no nausea rates. Data were analyzed using a random effects model.

RESULTS

Sixteen trials (3848 patients) were identified. Results were separately analyzed for (a) pure MEC regimens (excluding regimens containing carboplatin or oxaliplatin), (b) carboplatin-based regimens, and (c) oxaliplatin-based regimens. (a) Two trials (abstracts) enrolled 715 patients. The odds ratio for overall CR with the addition of an NK1-RA was 1.46 (95% 1.06-2.02; p = 0.02) with an absolute risk difference (RD) of 8%. (b) Nine trials (1790 patients) were identified. The OR for achieving an overall CR was 1.96 (95% CI 1.57-2.45; p < 0.00001) in favor of the NK1RA containing regimen with an RD of 15%. (c) Three trials (1190 patients) were identified. The OR for achieving an overall CR was 1.34 (95% CI 0.88-2.04; p = 0.17) not reaching statistical significance with a RD of 4%.

CONCLUSION

Clear clinically significant benefit was seen with the addition of NK1RAs in carboplatin-based chemotherapy. A global benefit of an NK1RA containing regimen for the whole MEC category cannot be attested yet and warrants more randomized trials exclusively testing pure MEC regimens without carboplatin.

摘要

目的

本系统评价评估了神经激肽-1受体拮抗剂(NK1RAs)在预防除蒽环类-环磷酰胺方案外的中度致吐性化疗(MEC)中化疗引起的恶心和呕吐(CINV)的疗效。

方法

对MEDLINE(通过PubMed和OVID)及Central数据库进行系统评价,并检索主要肿瘤学会议,以确定评估NK1RAs联合5-羟色胺受体拮抗剂(5-HT RA)及糖皮质激素用于管理CINV的随机试验。疗效终点为完全缓解(CR)、无呕吐和无恶心率。采用随机效应模型分析数据。

结果

共纳入16项试验(3848例患者)。结果分别针对(a)单纯MEC方案(不包括含卡铂或奥沙利铂的方案)、(b)含卡铂方案和(c)含奥沙利铂方案进行分析。(a)两项试验(摘要)纳入715例患者。加用NK1-RA后的总体CR优势比为1.46(95% 1.06 - 2.02;p = 0.02),绝对风险差(RD)为8%。(b)确定了9项试验(1790例患者)。含NK1RA方案实现总体CR的优势比为1.96(95% CI 1.57 - 2.45;p < 0.00001),RD为15%。(c)确定了3项试验(1190例患者)。实现总体CR的优势比为1.34(95% CI 0.88 - 2.04;p = 0.17),未达到统计学显著性,RD为4%。

结论

在含卡铂的化疗中加用NK1RAs有明显的临床显著获益。含NK1RA方案对整个MEC类别是否具有整体获益尚未得到证实,需要更多专门针对不含卡铂的单纯MEC方案的随机试验。

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