复发性或转移性头颈部鳞状细胞癌的系统治疗——系统评价和荟萃分析。
Systemic Therapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma- A Systematic Review and Meta-Analysis.
机构信息
Department of Oral and Maxillofacial Surgery, Prince Phillip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong Special Administrative Region.
Department of Oral and Maxillofacial Surgery, Prince Phillip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong Special Administrative Region.
出版信息
Crit Rev Oncol Hematol. 2020 Sep;153:102984. doi: 10.1016/j.critrevonc.2020.102984. Epub 2020 May 30.
BACKGROUND
The most effective regimen is unclear for patients with recurrent or metastatic head and neck squamous cell carcinomas (R/M HNSCC). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) investigating only systemic therapy for R/M HNSCC.
METHODS
This systematic review followed PRISMA and the Cochrane Collaboration Handbook for Systematic Reviews of Interventions. Endpoints included overall survival (OS), progression-free survival (PFS) and overall response rates (ORR).
RESULTS
55 RCTs from 1990-November 2019 qualified for review (n=12132). Only PD-1/PDL-1 inhibitors increased OS in R/M HNSCC platinum-resistant disease against their control (HR = 0·79, 95%CI 0·70-0.90, p<0·001), especially for PD-L1 ≥ 1% expressing tumours (HR = 0·72, 95%CI 0·60-0·86, p<0·001). PFS was prolonged for anti-EGFR agents against methotrexate when used in a second line setting (HR = 0·74, 95 %CI 0·62-0·87, p=0·001), and when cetuximab (HR = 0·60, 95%CI 0·49-0·72, p<0·0001) and panitumumab (HR = 0·76, 95%CI 0·65-0·89, p=0·001) were introduced to platinum-based regimens for first-line treatment.
CONCLUSIONS
PD-1/PD-L1 inhibitors may represent the future of R/M HNSCC treatment. However, EGFR inhibitors may still play improve clinical outcomes.
背景
对于复发性或转移性头颈部鳞状细胞癌（R/M HNSCC）患者，最有效的治疗方案尚不清楚。我们对仅针对 R/M HNSCC 进行全身治疗的随机对照试验（RCT）进行了系统评价和荟萃分析。
方法
本系统评价遵循 PRISMA 和 Cochrane 协作组干预措施系统评价手册。终点包括总生存期（OS）、无进展生存期（PFS）和总缓解率（ORR）。
结果
1990 年至 2019 年 11 月期间的 55 项 RCT 符合审查条件（n=12132）。只有 PD-1/PDL-1 抑制剂在 R/M HNSCC 铂类耐药疾病中相对于对照组增加了 OS（HR=0.79，95%CI 0.70-0.90，p<0.001），特别是对 PD-L1≥1%表达的肿瘤（HR=0.72，95%CI 0.60-0.86，p<0.001）。在二线治疗中，抗 EGFR 药物（西妥昔单抗 HR=0.60，95%CI 0.49-0.72，p<0.0001；帕尼单抗 HR=0.76，95%CI 0.65-0.89，p=0.001）和 panitumumab（HR=0.76，95%CI 0.65-0.89，p=0.001）用于二线治疗时，与甲氨蝶呤相比，PFS 延长。
结论
PD-1/PD-L1 抑制剂可能代表 R/M HNSCC 治疗的未来。然而，EGFR 抑制剂可能仍然可以改善临床结果。
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