Cancer Centre, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Lingnan Medical Research Centre, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
J Int Med Res. 2022 Nov;50(11):3000605221132703. doi: 10.1177/03000605221132703.
To conduct a network meta-analysis of randomised controlled trials to determine the optimal clinical choice of first-line therapy for patients with ALK receptor tyrosine kinase () gene rearrangement non-small cell lung cancer (NSCLC).
Clinical trials in patients with histologically confirmed gene rearrangement NSCLC, that included ALK inhibitors as first-line therapy, were identified using database searches. A Bayesian network meta-analysis was conducted to calculate the efficacy and safety of the included first-line treatments.
Nine trials with 2,407 patients were included for analyses. Lorlatinib was better than brigatinib for progression-free survival (PFS) (hazard ratio 0.79, 95% confidence interval 0.63, 0.98). In subgroup analyses, lorlatinib exhibited the highest probability of best PFS ranking in patients with or without baseline brain metastases (38% and 80%, respectively); brigatinib had the highest probability of best PFS ranking among Asian patients (47%). Alectinib offered the highest survival advantage (57% probability), while lorlatinib was likely to be the best treatment for an objective response (41% probability). Alectinib displayed the highest probability of being ranked lowest for grade ≥3 adverse events (86%).
Lorlatinib was associated with the best PFS overall, and was suitable for patients with or without brain metastases. Brigatinib was associated with the best PFS in Asian patients.
进行一项随机对照试验的网络荟萃分析，以确定具有 ALK 受体酪氨酸激酶（）基因重排的非小细胞肺癌（NSCLC）患者一线治疗的最佳临床选择。
通过数据库检索，确定了包含作为一线治疗的组织学证实的基因重排 NSCLC 患者的临床试验。采用贝叶斯网络荟萃分析计算纳入的一线治疗的疗效和安全性。
纳入了 9 项共 2407 例患者的试验进行分析。洛拉替尼在无进展生存期（PFS）方面优于布加替尼（风险比 0.79，95%置信区间 0.63，0.98）。在亚组分析中，洛拉替尼在有或无基线脑转移的患者中均具有最佳 PFS 排名的最高概率（分别为 38%和 80%）；在亚洲患者中，布加替尼具有最佳 PFS 排名的最高概率（47%）。阿来替尼提供了最高的生存优势（47%的概率），而洛拉替尼可能是客观反应的最佳治疗方法（41%的概率）。阿来替尼发生≥3 级不良事件的概率最低（86%）。
洛拉替尼总体上与最佳 PFS 相关，适合有或无脑转移的患者。布加替尼与亚洲患者的最佳 PFS 相关。
