Wang Lida, Song Jiwu, Xiao Xiangming, Li Dianfang, Liu Tianmeng, He Xiaopo
Department of E.N.T, Weifang People's Hospital, Weifang, China.
Department of Stomatology, Weifang People's Hospital, Weifang, Shandong, China.
J Chemother. 2024 May;36(3):202-207. doi: 10.1080/1120009X.2023.2247200. Epub 2023 Aug 20.
Because of lacking of head-to-head comparison between venetoclax and inhibitors (ivosidenib/enasidenib) for newly diagnosed unfit patients with acute myeloid leukemia (AML), the optimal option for these patients still remains undefined. We searched relevant published reports. Three RCTs with 180 mutant and 165 mutant patients were identified. Indirect comparison of OS using fixed effects network meta-analysis (NMA) models indicated venetoclax plus azacitidine (Ven-Aza) significantly improved survival than enasidenib plus azacitidine (Ena-Aza) (HR:0.30, = 0.005) for those newly diagnosed patients with AML and Mutation. And, for those mutation patients, Ven-Aza also had the highest probability of 98.3% (OS analysis) and 84.0% (CR/CRi analysis) to be the best intervention among these first-line treatment regimens (Ven-Aza, Ena-Aza and Aza). And, there was a favorable trend towards Ven-Aza in survival analysis (HR:0.69, = 0.42), when compared to ivosidenib plus azacitidine (Ivo-Aza) for those newly diagnosed patients with AML and Mutation. For those Mutation, venetoclax plus azacitidine (Ven-Aza) had the highest probability of 65.8% (OS analysis) and 73.0% (CR/CRi analysis) to be the best intervention among these first-line treatment regimens (Ven-Aza, ivosidenib plus azacitidine (Ivo-Aza) and azacitidine (Aza)). In conclusion, venetoclax plus azacitidine could be a good option for unfit newly diagnosed patients with acute myeloid leukemia and mutation. Considering our limits (only trial data-based network meta-analysis et al.), future trials directly comparing these regimens are warranted.
由于缺乏维奈托克与抑制剂（艾伏尼布/恩扎卢胺）针对新诊断的不适合进行强化化疗的急性髓系白血病（AML）患者的头对头比较，这些患者的最佳治疗选择仍不明确。我们检索了相关的已发表报告。确定了三项随机对照试验，涉及180例 突变和165例 突变患者。使用固定效应网络荟萃分析（NMA）模型对总生存期（OS）进行间接比较表明，对于那些新诊断的AML和 突变患者，维奈托克联合阿扎胞苷（Ven-Aza）比恩扎卢胺联合阿扎胞苷（Ena-Aza）显著提高了生存率（风险比：0.30，P = 0.005）。而且，对于那些 突变患者，在这些一线治疗方案（Ven-Aza、Ena-Aza和阿扎胞苷）中，Ven-Aza成为最佳干预措施的概率在OS分析中也最高，为98.3%，在完全缓解/血液学不完全缓解（CR/CRi）分析中为84.0%。并且，对于那些新诊断的AML和 突变患者，与艾伏尼布联合阿扎胞苷（Ivo-Aza）相比，在生存分析中Ven-Aza有一个有利趋势（风险比：0.69，P = 0.42）。对于那些 突变患者，在这些一线治疗方案（Ven-Aza、艾伏尼布联合阿扎胞苷（Ivo-Aza）和阿扎胞苷）中，维奈托克联合阿扎胞苷（Ven-Aza）成为最佳干预措施的概率在OS分析中为65.8%，在CR/CRi分析中为73.0%。总之，维奈托克联合阿扎胞苷可能是新诊断的不适合进行强化化疗的急性髓系白血病和 突变患者的一个良好选择。考虑到我们的局限性（仅基于试验数据的网络荟萃分析等），未来有必要进行直接比较这些方案的试验。
