Zhang Dan, Wu Jia-Rui, Duan Xiao-Jiao, Wang Kai-Huan, Zhao Yi, Ni Meng-Wei, Liu Shu-Yu, Zhang Xiao-Meng, Zhang Bing
Department of Clinical Chinese Pharmacy, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China.
Front Pharmacol. 2019 Jul 5;10:717. doi: 10.3389/fphar.2019.00717. eCollection 2019.
Several taxane-based chemotherapy regimens are effective in the treatment of gastric cancer; nevertheless, their comparative efficacy and safety remain disputed. This network meta-analysis (NMA) was designed to compare the efficacy and safety of different taxane-based chemotherapy regimens against gastric cancer. A comprehensive search was conducted to identify all relevant randomized controlled trials (RCTs) in multiple electronic databases. A Bayesian NMA was performed to combine the direct and indirect evidence and estimate the comparative efficacy and safety of different taxane-based chemotherapy regimens simultaneously by utilizing WinBUGS 1.4.3 and Stata 13.1 software. The efficacy outcomes included overall survival rate (OS), progression-free survival (PFS), and overall response rate (ORR), and the safety outcomes were adverse reactions (ADRs), namely, neutropenia, leucopenia, vomiting, and fatigue. A total of 37 RCTs were identified involving 7,178 patients with gastric cancer, and 10 taxane-based chemotherapy regimens (RT, T, TC, TCF, TF, TO, TOF, mTCF, mTF, and mTOF) were collected in gastric cancer therapy. According to the results of cluster analysis, compared with other taxane-based chemotherapy regimens, the regimens of TOF, mTCF, and TF were associated with the most favorable clinical efficacy in improving OS, PFS, and ORR. On the other hand, the regimens of T and mTF had the potential to be the most tolerable and acceptable therapeutic alternative in terms of ADRs. The current NMA provides the evidence that the combination of taxanes (paclitaxel or docetaxel) and fluorouracil is associated with the most preferable and beneficial option for patients with gastric cancer, although additional results from multicenter trials and high-quality studies will be pivotal for supporting our findings.
几种基于紫杉烷的化疗方案在胃癌治疗中有效；然而，它们的相对疗效和安全性仍存在争议。本网络荟萃分析（NMA）旨在比较不同基于紫杉烷的化疗方案治疗胃癌的疗效和安全性。进行了全面检索，以识别多个电子数据库中所有相关的随机对照试验（RCT）。利用WinBUGS 1.4.3和Stata 13.1软件进行贝叶斯NMA，以合并直接和间接证据，并同时估计不同基于紫杉烷的化疗方案的相对疗效和安全性。疗效结果包括总生存率（OS）、无进展生存期（PFS）和总缓解率（ORR），安全性结果为不良反应（ADR），即中性粒细胞减少、白细胞减少、呕吐和疲劳。共识别出37项RCT，涉及7178例胃癌患者，收集了10种基于紫杉烷的化疗方案（RT、T、TC、TCF、TF、TO、TOF、mTCF、mTF和mTOF）用于胃癌治疗。根据聚类分析结果，与其他基于紫杉烷的化疗方案相比，TOF、mTCF和TF方案在改善OS、PFS和ORR方面具有最有利的临床疗效。另一方面，就ADR而言，T和mTF方案有可能是最可耐受和可接受的治疗选择。目前的NMA提供了证据，表明紫杉烷（紫杉醇或多西他赛）与氟尿嘧啶联合使用对胃癌患者是最优选和有益的选择，尽管多中心试验和高质量研究的更多结果对于支持我们的发现至关重要。
