晚期或转移性胃癌和胃食管交界癌的靶向药物疗效和安全性：一项网络荟萃分析。

Efficacy and safety of targeted drugs in advanced or metastatic gastric and gastroesophageal junction cancer: A network meta-analysis.

机构信息

Provincial-Level Key Laboratory of Molecular Medicine of Major Diseases and Study on Prevention and Treatment of Traditional Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.

Basic Medical College, Gansu University of Chinese Medicine, Lanzhou, Gansu, China.

出版信息

J Clin Pharm Ther. 2022 Apr;47(4):493-506. doi: 10.1111/jcpt.13570. Epub 2021 Nov 18.

DOI:10.1111/jcpt.13570

PMID:34796971

Abstract

WHAT IS KNOWN AND OBJECTIVE

An increasing number of targeted drugs have been used to treat advanced or metastatic gastric cancer (GC) and gastroesophageal junction cancer (GEJC). However, the optimal treatment efficacy of these drugs is still controversial. The aims of this study are to systematically summarize the efficacy and safety of current targeted drugs for advanced or metastatic GC and GEJC.

METHODS

PubMed, EmBase, Cochrane Library, Web of Science and ClinicalTrials were searched for double-blind randomized controlled trials (RCTs) on GC and GEJC up to December 2019. Additionally, we updated the literature search from Jan, 1, 2020 to September 30, 2021. Narrative and quantitative analysis were performed to analyse the efficacy and safety. STATA 15.1 was used to identify publication bias, and the SUCRA (surface under the cumulative ranking) curve was conducted to rank the treatments for each outcome.

RESULTS

A total of 27 RCTs with 9295 GC and GEJC patients treated by 19 drugs were included. SUCRA showed that regorafenib was the most likely to improve patients' progression-free survival (96.4%), followed by apatinib (90.7%), nivolumab (82.4%), everolimus (76.5%) and pertuzumab (68.5%). Meanwhile, apatinib (92.4%) was most likely to improve overall survival, followed by nivolumab (87.9%), regorafenib (72.5%), olaparib (67.7%) and lapatinib (63.2%). Additionally, neutropenia, diarrhoea and fatigue were the most common adverse events caused by these drugs, followed by pain, nausea, decreased appetite, anaemia and vomiting.

WHAT IS NEW AND CONCLUSION

Regorafenib and nivolumab have higher efficacy and tolerability and are the most advantageous for advanced GC and GEJC. Moreover, apatinib has higher efficacy but lower tolerability. Everolimus and pertuzumab combined with chemotherapy have best secondary higher efficacy for progression-free survival and good tolerability. Lapatinib and olaparib combined with chemotherapy have moderate efficacy for overall survival and good tolerability.

摘要

已知和目的

越来越多的靶向药物被用于治疗晚期或转移性胃癌（GC）和胃食管交界癌（GEJC）。然而，这些药物的最佳治疗效果仍存在争议。本研究旨在系统总结目前用于治疗晚期或转移性 GC 和 GEJC 的靶向药物的疗效和安全性。

方法

检索了截至 2019 年 12 月的 PubMed、EmBase、Cochrane 图书馆、Web of Science 和 ClinicalTrials 中关于 GC 和 GEJC 的双盲随机对照试验（RCT）。此外，我们从 2020 年 1 月 1 日至 2021 年 9 月 30 日更新了文献检索。采用叙述性和定量分析来分析疗效和安全性。STATA 15.1 用于识别发表偏倚，并用 SUCRA（累积排序曲线下面积）曲线对每种结局的治疗方法进行排名。

结果

共纳入 27 项 RCT，9295 例 GC 和 GEJC 患者接受 19 种药物治疗。SUCRA 显示regorafenib 最有可能改善患者的无进展生存期（96.4%），其次是 apatinib（90.7%）、nivolumab（82.4%）、everolimus（76.5%）和 pertuzumab（68.5%）。同时，apatinib（92.4%）最有可能改善总生存期，其次是 nivolumab（87.9%）、regorafenib（72.5%）、olaparib（67.7%）和 lapatinib（63.2%）。此外，中性粒细胞减少症、腹泻和疲劳是这些药物最常见的不良反应，其次是疼痛、恶心、食欲下降、贫血和呕吐。

创新性和结论

regorafenib 和 nivolumab 具有更高的疗效和耐受性，对晚期 GC 和 GEJC 最有利。此外，apatinib 具有更高的疗效但耐受性更低。everolimus 和 pertuzumab 联合化疗对无进展生存期有最佳的二级更高疗效，且耐受性良好。lapatinib 和 olaparib 联合化疗对总生存期有中等疗效，且耐受性良好。