He Jiaxi, Pan Hui, He Jianxing, Li Shuben
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.
Ann Transl Med. 2021 Aug;9(16):1285. doi: 10.21037/atm-21-963.
Small cell lung cancer (SCLC) is highly invasive and poorly prognostic. The effects of chemotherapy with bevacizumab are promising on other tumors but unclear in extensive-disease SCLC (ED-SCLC). A systemic review and meta-analysis were performed to investigate the efficacy and toxicity in ED-SCLC patients.
A review of current studies was performed on electronic databases and other sources to identify publications of ED-SCLC patients who received bevacizumab. Endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and complications.
Nine relevant articles with six single-arm and three two-arm studies were identified. Four hundred seventy-six patients were included, of which 368 and 108 were untreated and relapse patients. Most patients were performance status 0-1 (71.6%) and male (58.1%). The comparisons showed CT/bevacizumab slightly prolonged OS (HR =0.84) but significantly improved PFS (HR =0.74). The ORRs of untreated and relapse patients were 71% and 19%, though no significant difference was observed than CT/placebo. The most grade 3-4 complication and bevacizumab-associated complications were neutropenia and hypertension, whose rates were 33% and 6%. Patients who received CT/bevacizumab had a higher hypertension rate than CT/placebo (6% 2%). No different complication rate was observed between high and lose dose groups.
The present study suggests that bevacizumab in the combination of standard chemotherapy provides better PFS than chemotherapy alone. Although the combined regimen is well-tolerated, no superiority in OS or response rate is observed.
小细胞肺癌（SCLC）具有高度侵袭性，预后较差。贝伐单抗化疗对其他肿瘤的疗效有前景，但在广泛期小细胞肺癌（ED-SCLC）中尚不清楚。进行了一项系统评价和荟萃分析以研究ED-SCLC患者的疗效和毒性。
对电子数据库和其他来源进行当前研究的综述，以确定接受贝伐单抗治疗的ED-SCLC患者的出版物。终点包括总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、疾病控制率（DCR）和并发症。
确定了9篇相关文章，其中6篇单臂研究和3篇双臂研究。纳入476例患者，其中368例为未治疗患者，108例为复发患者。大多数患者的体能状态为0-1（71.6%），男性患者占58.1%。比较显示，化疗联合贝伐单抗可略微延长总生存期（HR = 0.84），但显著改善无进展生存期（HR = 0.74）。未治疗患者和复发患者的客观缓解率分别为71%和19%，但与化疗联合安慰剂相比无显著差异。最常见的3-4级并发症和与贝伐单抗相关的并发症是中性粒细胞减少和高血压，发生率分别为33%和6%。接受化疗联合贝伐单抗的患者高血压发生率高于化疗联合安慰剂（6%对2%）。高剂量组和低剂量组之间未观察到不同的并发症发生率。
本研究表明，标准化疗联合贝伐单抗比单纯化疗具有更好的无进展生存期。虽然联合方案耐受性良好，但在总生存期或缓解率方面未观察到优势。
