Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Gynecologic Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Aging (Albany NY). 2022 Feb 26;14(4):1959-1982. doi: 10.18632/aging.203919.
Paclitaxel remains the first-line chemotherapy regimen for many malignant tumors. However, prognosis and adverse events under different dosing regimens (one-week versus three-week treatment) remain contradictory in many randomized controlled trials (RCTs). Here, we performed a comprehensive meta-analysis to measure the efficacy and toxicities of these two dosing regimens. Four databases were systematically retrieved. RCTs comparing two paclitaxel dosing regimens for advanced malignant tumors with assessable outcomes (e.g., overall survival (OS), progression-free survival (PFS), toxicities, response rates) were included. In total, 19 eligible RCTs involving 9 674 patients were included. Meta-analysis of pan-cancers revealed that weekly paclitaxel treatment was more beneficial regarding PFS compared to three-week paclitaxel treatment (hazard ratio (HR) = 0.90, 95% confidence interval (CI) = 0.82-0.99, = 0.02). Nevertheless, there was no significant difference in terms of OS between the two dosing regimens (HR = 0.98, 95%CI = 0.91-1.06, = 0.62) or other tested subgroups. In terms of serious adverse events, grade 3 or 4 (G3/4) neutropenia, G3/4 febrile neutropenia, G3/4 arthritis, and G3/4 alopecia occurred less often under weekly paclitaxel treatment. In summary, Weekly paclitaxel treatment demonstrates better PFS and fewer chemotherapy-induced hematological and non-hematological toxicities compared to the three-week paclitaxel regimen.
紫杉醇仍然是许多恶性肿瘤的一线化疗方案。然而，在许多随机对照试验（RCT）中，不同剂量方案（一周与三周治疗）下的预后和不良事件仍然存在矛盾。在这里，我们进行了一项全面的荟萃分析，以衡量这两种剂量方案的疗效和毒性。系统检索了四个数据库。纳入比较两种紫杉醇剂量方案治疗可评估结局（如总生存期（OS）、无进展生存期（PFS）、毒性、缓解率）的晚期恶性肿瘤的 RCT。共有 19 项符合条件的 RCT 纳入了 9674 名患者。泛癌种的荟萃分析表明，与三周紫杉醇治疗相比，每周紫杉醇治疗在 PFS 方面更有益（风险比（HR）=0.90，95%置信区间（CI）=0.82-0.99，=0.02）。然而，两种剂量方案在 OS 方面没有显著差异（HR=0.98，95%CI=0.91-1.06，=0.62）或其他测试亚组。在严重不良事件方面，每周紫杉醇治疗较少发生 3 级或 4 级（G3/4）中性粒细胞减少症、G3/4 发热性中性粒细胞减少症、G3/4 关节炎和 G3/4 脱发。总之，与三周紫杉醇方案相比，每周紫杉醇治疗可获得更好的 PFS 并减少化疗引起的血液学和非血液学毒性。
