Division of Hemato-Oncology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Division of Hemato-Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Crit Rev Oncol Hematol. 2021 Nov;167:103505. doi: 10.1016/j.critrevonc.2021.103505. Epub 2021 Oct 14.
We conducted a systemic literature review of randomized controlled trials (RCTs) to identify phase III RCTs on salvage treatment of advanced gastric cancer (AGC) and performed a Bayesian network meta-analysis with random-effects model. The overall survival (OS) was the primary outcome of interest. A total of 20 randomized phase III trials were selected. For the second-line treatment, olaparib plus paclitaxel had the highest surface under the cumulative ranking curve value (90.5%), followed by paclitaxel plus ramucirumab (88.4%) and pembrolizumab (86.5%), indicating that these treatments could be the most effective regimens in terms of OS. Nivolumab, chemotherapy, and apatinib showed significant OS benefit compared with best supportive care for the third-line treatment. In conclusion, pembrolizumab may be the most preferable regimen as a second-line treatment for patients with PD-L1-expressing AGC, while paclitaxel-based combinations are recommended for PD-L1-negative AGC. Nivolumab might be the most preferable third-line treatment.
我们进行了一项系统的文献综述，以确定晚期胃癌（AGC）挽救治疗的 III 期随机对照试验（RCT），并采用随机效应模型进行贝叶斯网络荟萃分析。总生存期（OS）是主要的观察终点。共纳入 20 项随机 III 期试验。对于二线治疗，奥拉帕利联合紫杉醇的累积排序曲线下面积（SUCRA）值最高（90.5%），其次是紫杉醇联合雷莫芦单抗（88.4%）和帕博利珠单抗（86.5%），表明这些治疗方案在 OS 方面可能是最有效的。对于三线治疗，纳武利尤单抗、化疗和阿帕替尼与最佳支持治疗相比具有显著的 OS 获益。总之，对于 PD-L1 表达的 AGC 患者，帕博利珠单抗可能是二线治疗的最佳选择，而对于 PD-L1 阴性的 AGC，推荐使用基于紫杉醇的联合方案。纳武利尤单抗可能是三线治疗的最佳选择。
