Department of Pharmacology, Hebei Medical University, Shijiazhuang, China.
Department of Pharmacy, Hebei Children's Hospital of Hebei Medical University, Shijiazhuang, China.
Pharmacotherapy. 2019 Dec;39(12):1126-1136. doi: 10.1002/phar.2344. Epub 2019 Nov 24.
To compare the effectiveness of different taxane-containing regimens and to identify the best strategy for the treatment of human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC).
Network meta-analysis of 20 randomized controlled trials (RCTs).
A total of 6577 patients with HER2-negative MBC who received treatment (20 different regimens) with taxanes (paclitaxel [4267 patients] or docetaxel [2310 patients]).
The PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched (through March 2019) for RCTs that evaluated any taxane-containing regimens for the treatment of HER2-negative MBC. A network meta-analysis in a Bayesian framework was performed using the random-effects model. We compared the surface under the cumulative ranking (SUCRA) curve for each regimen. Overall, paclitaxel-based combinations were superior to paclitaxel alone in objective response rate (ORR) (odds ratio 1.60, 95% credible interval [CrI] 1.15-2.16) and overall survival (OS) (hazard ratio 1.08, 95% CrI 1.01-1.15). Docetaxel-based combinations were also superior to paclitaxel alone in ORR. Among the paclitaxel-based regimens, based on the results of SUCRA, paclitaxel + bevacizumab + capecitabine was likely to be the most efficacious in improving ORR, OS, and progression-free survival (PFS), whereas paclitaxel + gemcitabine was likely to be the most efficacious in 1-year OS rate. Among the docetaxel-based regimens, based on the results of SUCRA, docetaxel + gemcitabine was likely to be the most efficacious in improving PFS and OS.
These findings demonstrated that paclitaxel-based combinations can provide significant improvement in ORR and OS compared with paclitaxel alone. The regimens of paclitaxel + bevacizumab + capecitabine, docetaxel + gemcitabine, and paclitaxel + gemcitabine may be superior to other regimens for the treatment of HER2-negative MBC.
比较不同含紫杉烷方案的疗效，并确定人表皮生长因子受体 2（HER2）阴性转移性乳腺癌（MBC）的最佳治疗策略。
20 项随机对照试验（RCT）的网络荟萃分析。
共 6577 例接受紫杉烷（紫杉醇 4267 例，多西紫杉醇 2310 例）治疗的 HER2 阴性 MBC 患者（20 种不同方案）。
通过 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov 数据库检索（截至 2019 年 3 月），评估任何含紫杉烷方案治疗 HER2 阴性 MBC 的 RCT。使用随机效应模型进行贝叶斯框架下的网络荟萃分析。我们比较了每种方案的累积排序曲线下面积（SUCRA）。总体而言，与紫杉醇单药相比，紫杉醇联合方案在客观缓解率（ORR）（优势比 1.60，95%可信区间[CrI] 1.15-2.16）和总生存期（OS）（风险比 1.08，95%CrI 1.01-1.15）方面更具优势。多西紫杉醇联合方案也优于紫杉醇单药在 ORR 方面。在紫杉醇联合方案中，基于 SUCRA 的结果，紫杉醇+贝伐珠单抗+卡培他滨在提高 ORR、OS 和无进展生存期（PFS）方面可能是最有效的，而紫杉醇+吉西他滨在 1 年 OS 率方面可能是最有效的。在多西紫杉醇联合方案中，基于 SUCRA 的结果，多西紫杉醇+吉西他滨在改善 PFS 和 OS 方面可能是最有效的。
这些发现表明，与紫杉醇单药相比，紫杉醇联合方案可显著提高 ORR 和 OS。对于 HER2 阴性 MBC 的治疗，紫杉醇+贝伐珠单抗+卡培他滨、多西紫杉醇+吉西他滨和紫杉醇+吉西他滨方案可能优于其他方案。
