Li Xiaofei, Zhang Daofu, Guan Shan, Ye Weiwei, Liu Liwen, Lou Lianqing
Department of Infectious Diseases, Yi Wu Central Hospital, Zhejiang Province, 322000, China.
Liao Cheng City People's Hospital, Shandong Province, 252000, China.
Oncotarget. 2017 Oct 3;8(54):93179-93185. doi: 10.18632/oncotarget.21452. eCollection 2017 Nov 3.
We aimed to investigate the role of anti-vascular endothelial growth factor (VEGF) agents, including tyrosine-kinase inhibitors or monoclonal anti-bodies, in the treatment of elderly hepatocellular carcinoma (HCC) patients.
Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to March 31, 2017 were searched to identify relevant studies. The endpoints were overall survival (OS) and progression-free survival (PFS). Data were examined using age cutoffs of 65 years.
A total of 1,309 elderly (aged ≥ 65 years) HCC patients from seven trials were included for analysis. Our results demonstrated that the use of anti-VEGF agents MTAs in patients aged ≥ 65 years significantly improved PFS (HR 0.65, 95% CI: 0.55-0.76, < 0.001) but not for OS (HR 0.87, 95% CI: 0.73-1.05, = 0.15). Sub-group analysis according to treatment line showed that the use of anti-VEGF agents as second-line treatment significantly improved PFS (HR 0.55, 95% CI: 0.45-0.67, < 0.001) and marginally improved OS (HR 0.83, 95% CI: 0.68-1.01, = 0.061). Additionally, no survival benefits were observed in elderly HCC received first-line anti-VEGF treatments in terms of PFS (HR 0.87, 95% CI: 0.67-1.13, = 0.29) and OS (HR 1.19, 95% CI: 0.74-1.36, = 0.47). No publication bias was detected by Begg's and Egger's tests for OS.
The findings of this study show that elderly HCC patients who relapsed after a first-line sorafenib treatment obtains a survival benefits from anti-VEGF agents rechallenge. Further studies are recommended to search for predictors of good responders in these patients received anti-VEGF agents.
我们旨在研究抗血管内皮生长因子（VEGF）药物，包括酪氨酸激酶抑制剂或单克隆抗体，在老年肝细胞癌（HCC）患者治疗中的作用。
检索截至2017年3月31日的PubMed、科学网数据库以及美国临床肿瘤学会（ASCO）会议上发表的摘要，以确定相关研究。终点指标为总生存期（OS）和无进展生存期（PFS）。使用65岁的年龄界限对数据进行分析。
共纳入来自7项试验的1309例老年（年龄≥65岁）HCC患者进行分析。我们的结果表明，在年龄≥65岁的患者中使用抗VEGF药物显著改善了PFS（风险比[HR]0.65，95%置信区间[CI]：0.55 - 0.76，P<0.001），但对OS无显著影响（HR 0.87，95%CI：0.73 - 1.05，P = 0.15）。根据治疗线进行的亚组分析显示，使用抗VEGF药物作为二线治疗可显著改善PFS（HR 0.55，95%CI：0.45 - 0.67，P<0.001），对OS有轻微改善（HR 0.83，95%CI：0.68 - 1.01，P = 0.061）。此外，在接受一线抗VEGF治疗的老年HCC患者中，未观察到PFS（HR 0.87，95%CI：0.67 - 1.13，P = 0.29）和OS（HR 1.19，95%CI：0.74 - 1.36，P = 0.47）方面的生存获益。通过Begg检验和Egger检验未检测到OS的发表偏倚。
本研究结果表明，一线索拉非尼治疗后复发的老年HCC患者接受抗VEGF药物再次治疗可获得生存获益。建议进一步研究寻找这些接受抗VEGF药物治疗患者中的良好反应预测指标。
