Department of Respiratory Medicine, The First College of Clinical Medicine Science, Three Gorges University, No. 183 Yiling Road, Yichang, 443003, People's Republic of China.
Department of Respiratory Medicine, Yichang Central People's Hospital, Yichang, China.
Support Care Cancer. 2020 Jul;28(7):3291-3301. doi: 10.1007/s00520-019-05096-2. Epub 2019 Nov 21.
Zoledronic acid (ZA) and strontium-89 have been widely used to treat lung cancer with bone metastases. The authors perform this meta-analysis to better evaluate the clinical outcome of ZA and strontium-89 for non-small cell lung cancer (NSCLC) patients.
We carried out standard meta-analysis and network meta-analysis based on a comprehensive data retrieval of EMBASE, PubMed, and Cochrane Library databases (up to March 2019). Random and fixed effects models were used where indicated and between-study heterogeneity was assessed. The primary endpoints were overall survival (OS) and skeletal-related events (SREs). The second endpoints were progression-free survival (PFS) and overall response rate (ORR).
Seven randomized clinical trials, including 1426 NSCLC patients with seven studies of zoledronic acid and two studies of strontium-89, met the inclusion criteria. Compared with the control group, ZA is associated with a OS benefit (1-year survival rate: RR = 1.76, 95% CI 1.36-2.27; and 24-month survival rate: RR = 2.38, 95% CI 1.35-4.19) and a reduction of SREs (RR = 0.57, 95% CI 0.40-0.84) for the patients with bone metastases. No statistical differences were found in PFS and ORR. Network meta-analysis for the patients with bone metastases showed that ZA + strontium-89 and ZA harbored significantly clinical benefits than strontium-89 and placebo in terms of 1-year survival rate and SREs. Both head-to-head study and network meta-analysis showed that strontium-89 had no statistical impact on OS and SREs compared with placebo.
Our analysis demonstrates that ZA +strontium-89 can be considered a priority for NSCLC patients with bone metastases, followed by ZA.
唑来膦酸（ZA）和锶-89 已被广泛用于治疗肺癌伴骨转移。作者进行这项荟萃分析，以更好地评估 ZA 和锶-89 治疗非小细胞肺癌（NSCLC）患者的临床疗效。
我们对 EMBASE、PubMed 和 Cochrane Library 数据库进行了全面检索（截至 2019 年 3 月），开展了标准荟萃分析和网络荟萃分析。在有指征的情况下使用随机和固定效应模型，并评估了研究间的异质性。主要终点为总生存期（OS）和骨骼相关事件（SREs）。次要终点为无进展生存期（PFS）和总缓解率（ORR）。
符合纳入标准的有 7 项随机临床试验，包括 1426 例 NSCLC 伴骨转移患者，其中 7 项研究使用了唑来膦酸，2 项研究使用了锶-89。与对照组相比，ZA 可使 OS 获益（1 年生存率：RR=1.76，95%CI 1.36-2.27；24 个月生存率：RR=2.38，95%CI 1.35-4.19），并降低 SREs（RR=0.57，95%CI 0.40-0.84）。PFS 和 ORR 无统计学差异。骨转移患者的网络荟萃分析显示，ZA+锶-89 和 ZA 在 1 年生存率和 SREs 方面比锶-89 和安慰剂具有显著的临床获益。直接比较研究和网络荟萃分析均显示，锶-89 与安慰剂相比，对 OS 和 SREs 无统计学影响。
我们的分析表明，ZA+锶-89 可被视为伴有骨转移的 NSCLC 患者的优先治疗选择，其次是 ZA。
