三药化疗联合抗 EGFR 药物治疗转移性结直肠癌的疗效和安全性：系统评价和荟萃分析。

Efficacy and safety of triplet chemotherapy plus anti-EGFR agents in metastatic colorectal cancer: a systematic review and meta-analysis.

机构信息

Department of Oncology, Shenzhen Luohu People's Hospital, Shenzhen, Guangdong, 518000, People's Republic of China.

出版信息

World J Surg Oncol. 2022 Aug 15;20(1):258. doi: 10.1186/s12957-022-02707-x.

BACKGROUND

To date, the optimal treatment for potentially resectable metastatic colorectal cancer (mCRC) patients has yet to be determined. Encouraging results have been reported in studies exploring the efficacy of triplet chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) target agents. Thus, we conducted a meta-analysis to evaluate the efficacy and safety of triplet chemotherapy plus anti-EGFR target agents.

METHODS

We systematically searched the PubMed, Embase, and Web of Science databases from December 2004 to October 2021 for studies examining the efficacy of triplet chemotherapy plus anti-EGFR target agents in mCRC patients. The primary outcomes were the objective response rate (ORR) and R0 resection rate (R0RR), and the secondary outcomes were median progression-free survival (mPFS), median overall survival (mOS), and toxicity. Data were analyzed with R software 4.1.2.

RESULTS

Fourteen studies comprising 762 patients with mCRC were included in this meta-analysis. Analysis with a random effects model revealed that after treatment with triplet chemotherapy plus anti-EGFR target agents, the pooled ORR was 82% (95% CI= 76-88%, I= 76%), and the pooled R0RR of colorectal liver metastasis (CLM) was 59% (95% CI= 49-68%, I= 60%). The mPFS ranged from 9.5 to 17.8 months, and the mOS ranged from 24.7 to 62.5 months. A total of 648 grade 3 or 4 adverse events were reported; the most commonly reported events were diarrhea (174/648), neutropenia (157/648), and skin toxicity (95/648), which had pooled prevalence rates of 29% (95% CI= 20-39%, I= 84%), 28% (95% CI= 20-37%, I= 77%), and 17% (95% CI= 11-24%, I= 66%), respectively.

CONCLUSIONS

Triplet chemotherapy plus anti-EGFR agents therapy seems to be capable of increasing the ORR of mCRC patients and the R0RR of CLM patients. The toxicity of this treatment is manageable. High-quality randomized controlled trial (RCT) studies are required for further validation.

背景

迄今为止，尚未确定潜在可切除转移性结直肠癌（mCRC）患者的最佳治疗方法。探索三联化疗加抗表皮生长因子受体（anti-EGFR）靶向药物疗效的研究报告了令人鼓舞的结果。因此，我们进行了一项荟萃分析，以评估三联化疗加 anti-EGFR 靶向药物的疗效和安全性。

方法

我们系统地检索了 PubMed、Embase 和 Web of Science 数据库，以获取 2004 年 12 月至 2021 年 10 月期间研究三联化疗加 anti-EGFR 靶向药物治疗 mCRC 患者疗效的研究。主要结局指标为客观缓解率（ORR）和 R0 切除率（R0RR），次要结局指标为中位无进展生存期（mPFS）、中位总生存期（mOS）和毒性。使用 R 软件 4.1.2 进行数据分析。

结果

共有 14 项研究纳入了 762 例 mCRC 患者，该荟萃分析包括这些研究。使用随机效应模型分析显示，接受三联化疗加 anti-EGFR 靶向药物治疗后，ORR 为 82%（95%CI=76-88%，I=76%），结直肠癌肝转移（CLM）的 R0RR 为 59%（95%CI=49-68%，I=60%）。mPFS 范围为 9.5 至 17.8 个月，mOS 范围为 24.7 至 62.5 个月。共报告了 648 例 3 级或 4 级不良事件；最常见的不良事件是腹泻（174/648）、中性粒细胞减少症（157/648）和皮肤毒性（95/648），其总体发生率分别为 29%（95%CI=20-39%，I=84%）、28%（95%CI=20-37%，I=77%）和 17%（95%CI=11-24%，I=66%）。