对先前铂类化疗敏感的小细胞肺癌患者二线治疗的比较：一项系统评价和贝叶斯网络分析
Comparison of the second-line treatments for patients with small cell lung cancer sensitive to previous platinum-based chemotherapy: A systematic review and Bayesian network analysis.
作者信息
Shi Hekai, Guo Nuojin, Zhao Zeming, Liu Ligang, Ni Tianyi, Zhang Jinye, Lu Yingjie
机构信息
Department of Thoracic Surgery, Fudan University Affiliated Huadong Hospital, Shanghai, China.
Shanghai East Hospital, Tongji University, Shanghai, China.
出版信息
Front Oncol. 2023 Mar 16;13:1154685. doi: 10.3389/fonc.2023.1154685. eCollection 2023.
OBJECTIVE
It remains unclear what the best second-line treatment is for patients with small-cell lung cancer sensitive to previous platinum-based chemotherapy.
METHODS
We systematically screened randomized controlled trials from several online databases. The primary outcome was objective response rate (ORR), and the secondary outcomes were disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and hematological complications graded 3 to 5. The efficacy of included treatments was ranked by surface under the cumulative ranking curve (SUCRA) value.
RESULTS
We included eleven trials involving 1560 patients in quantitative analysis. Triple chemotherapy containing platinum (TP, combination of cisplatin, etoposide, and irinotecan) was associated with favorable ORR (intravenous topotecan vs TP; odds ratio: 0.13, 95% CI:0.03-0.63; SUCRA, 0.94) and PFS (vs intravenous topotecan; hazard ratio, 0.5; 95% CI: 0.25-0.99; SUCRA, 0.90). Belotecan ranked highest for OS (SUCRA, 0.90), while intravenous topotecan plus Ziv-aflibercept ranked highest for DCR (SUCRA, 0.75). TP was more likely to cause anemia and thrombocytopenia while intravenous topotecan plus Ziv-aflibercept resulted in most neutrocytopenia.
CONCLUSION
TP is the first recommendation for the second-line treatment of sensitive relapsed SCLC. TP achieved priority in ORR and PFS with the most frequent adverse effects in anemia and thrombocytopenia. For patients who cannot tolerate the hematological adverse effects of triple chemotherapy, amrubicin is an optional option. Amrubicin had relatively good ORR and PFS, accompanied by fewer hematological complications. The rechallenge of the platinum doublet is inferior to amrubicin in ORR, DCR, and PFS. Oral topotecan has a similar effect compared with IV topotecan, but oral topotecan was associated with slightly higher safety and less stress in nursing. Belotecan contributed to the best PFS with slightly better safety but was not ideal in other outcomes.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358256.
目的
对于对先前铂类化疗敏感的小细胞肺癌患者，最佳二线治疗方案仍不明确。
方法
我们系统地筛选了多个在线数据库中的随机对照试验。主要结局为客观缓解率（ORR），次要结局为疾病控制率（DCR）、总生存期（OS）、无进展生存期（PFS）以及3至5级血液学并发症。纳入治疗的疗效通过累积排名曲线下面积（SUCRA）值进行排序。
结果
我们纳入了11项试验，共1560例患者进行定量分析。含铂三联化疗（TP，顺铂、依托泊苷和伊立替康联合）与良好的ORR（静脉注射拓扑替康对比TP；比值比：0.13，95%置信区间：0.03 - 0.63；SUCRA，0.94）和PFS（对比静脉注射拓扑替康；风险比，0.5；95%置信区间：0.25 - 0.99；SUCRA，0.90）相关。贝洛替康在OS方面排名最高（SUCRA，0.90），而静脉注射拓扑替康加西伐珠单抗在DCR方面排名最高（SUCRA，0.75）。TP更易导致贫血和血小板减少，而静脉注射拓扑替康加西伐珠单抗导致的中性粒细胞减少最为常见。
结论
TP是敏感复发小细胞肺癌二线治疗的首选推荐。TP在ORR和PFS方面居优先地位，贫血和血小板减少的不良反应最为常见。对于无法耐受三联化疗血液学不良反应的患者，氨柔比星是一个可选方案。氨柔比星具有相对较好的ORR和PFS，血液学并发症较少。铂类双联化疗再挑战在ORR、DCR和PFS方面不如氨柔比星。口服拓扑替康与静脉注射拓扑替康效果相似，但口服拓扑替康安全性略高，护理压力较小。贝洛替康在PFS方面最佳，安全性略好，但在其他结局方面不理想。
系统评价注册
Zotero 插件