The First Clinical Medical Institute of Zhejiang Chinese Medical University, Hangzhou 310053, China.
Department of Integrated TCM & Western Medicine, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Biomed Res Int. 2018 May 28;2018:5839081. doi: 10.1155/2018/5839081. eCollection 2018.
To evaluate the effect of combination maintenance therapy of pemetrexed plus bevacizumab for patients with advanced non-small cell lung cancer.
We identified relevant studies by electronic search (Embase, PubMed, Cochrane, and Web of Science from 1 January 1960 to 29 October 2016) and manual search. The primary outcome of interest was progression-free survival (PFS) and secondary end point included overall survival (OS) and toxicities. The data was pooled for quantitative analysis and the final effect size was reported as hazard ratio (HR) for survival outcomes and relative risk (RR) for safety outcomes, both with a random-effects model.
Three randomized controlled trials enrolling 1302 patients with advanced non-small cell lung cancer were included in this meta-analysis. An evident PFS improvement (HR = 0.73, 95% CI = 0.63-0.83, < 0.01) was observed in patients with pemetrexed and bevacizumab combination maintenance therapy compared with single-agent maintenance therapy, yet it did not subsequently lead to a significant improvement in OS (HR = 0.97, 95% CI = 0.84-1.10, = 0.66). Our analysis also showed statistically increased risks for provoking grade 3-4 adverse events in patients managed using pemetrexed plus bevacizumab combination (RR = 1.59, 95% CI = 1.07-2.36, = 0.022).
Pemetrexed plus bevacizumab combination maintenance therapy leads to significant improvement in PFS but not in OS for patients with advanced non-small cell lung cancer, which also increases the risks of grade 3-4 adverse events. Yet, in view of the limitation of existing studies and this meta-analysis, current evidence is not adequate to support routine use of pemetrexed-bevacizumab maintenance.
评估培美曲塞联合贝伐单抗维持治疗晚期非小细胞肺癌患者的效果。
我们通过电子检索（从 1960 年 1 月 1 日至 2016 年 10 月 29 日的 Embase、PubMed、Cochrane 和 Web of Science）和手动检索来确定相关研究。主要观察终点为无进展生存期（PFS），次要终点包括总生存期（OS）和毒性。对数据进行汇总定量分析，报告生存结局的风险比（HR）和安全性结局的相对风险（RR），均采用随机效应模型。
这项荟萃分析纳入了 3 项纳入 1302 例晚期非小细胞肺癌患者的随机对照试验。与单药维持治疗相比，培美曲塞联合贝伐单抗维持治疗患者的 PFS 明显改善（HR=0.73，95%CI=0.63-0.83，<0.01），但 OS 并未显著改善（HR=0.97，95%CI=0.84-1.10，=0.66）。我们的分析还显示，使用培美曲塞联合贝伐单抗治疗的患者发生 3-4 级不良事件的风险统计学增加（RR=1.59，95%CI=1.07-2.36，=0.022）。
培美曲塞联合贝伐单抗维持治疗可显著改善晚期非小细胞肺癌患者的 PFS，但不能改善 OS，同时增加 3-4 级不良事件的风险。然而，鉴于现有研究和本荟萃分析的局限性，目前的证据不足以支持常规使用培美曲塞-贝伐单抗维持治疗。
