一线联合治疗与单药治疗对视神经视网膜淋巴瘤的疗效和安全性：系统评价和荟萃分析。
Efficacy and safety of first-line combination therapy versus monotherapy for vitreoretinal lymphoma: a systematic review and meta-analysis.
机构信息
Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
出版信息
BMC Ophthalmol. 2023 Nov 22;23(1):477. doi: 10.1186/s12886-023-03226-3.
BACKGROUND
Vitreoretinal lymphoma (VRL) is usually treated with a combination of intraocular methotrexate (ioMTX), high-dose intravenous methotrexate (HD-MTX), or local radiotherapy (RT) as the first options. The effectiveness and safety of monotherapy like bruton's tyrosine kinase inhibitors (BTKi) for PVRL remain uncertain.
METHODS
A systematic review and meta-analysis of clinical trial data and conference abstracts in VRL patients treated with first-line combination therapy or monotherapy were conducted through a search of PubMed, Embase, and Scopus databases until December 2022. A total of 24 studies comprising 517 patients were included, and survival data were extracted from 279 patients due to inconsistent units across studies.
RESULTS
The combined treatment group used ioMTX + chemotherapy (in 4 studies), RT + chemotherapy (in 2 studies), ioMTX/HD-MTX based regimen (in 2 studies), ioMTX + RT + chemotherapy (in 2 studies), ioMTX + lenalidomide/BTKi (in 2 studies) and combination of multiple therapies (in 7 studies). The monotherapy group was mainly treated with oral monotherapies such as BTKi. The combination therapy had a higher overall response rate (ORR) and complete response rate (CRR) than monotherapy (ORR: 96% vs. 72%, CRR: 92% vs. 63%). Combination therapy also resulted in a longer median progression-free survival (28.8 months vs. 13 months, p = 0.012). However, the combination therapy group had more severe side effects (grade 3/4 toxicity) than the monotherapy group (45% vs. 8%).
CONCLUSION
The study showed combination therapy had better OR and CR rates, longer survival, and more toxicity than monotherapy. While BTK inhibitors were well-tolerated, long-term effectiveness needs confirmation from prospective studies. In addition, given the small number of studies of monotherapy for VRL, more studies are needed to validate its effects.
TRIAL REGISTRATION
CRD42023400305.
背景
眼内淋巴瘤（VRL）通常采用眼内甲氨蝶呤（ioMTX）、大剂量静脉甲氨蝶呤（HD-MTX）和局部放疗（RT）联合治疗作为首选方案。对于原发性 VRL 患者，单药治疗如 Bruton 酪氨酸激酶抑制剂（BTKi）的疗效和安全性仍不确定。
方法
通过检索 PubMed、Embase 和 Scopus 数据库，对一线联合治疗或单药治疗 VRL 患者的临床试验数据和会议摘要进行系统评价和荟萃分析，检索截止日期为 2022 年 12 月。共纳入 24 项研究，包括 517 例患者，由于研究间单位不一致，从 279 例患者中提取生存数据。
结果
联合治疗组采用 ioMTX+化疗（4 项研究）、RT+化疗（2 项研究）、基于 ioMTX/HD-MTX 的方案（2 项研究）、ioMTX/HD-MTX+RT+化疗（2 项研究）、ioMTX+来那度胺/BTKi（2 项研究）和多种疗法联合（7 项研究）。单药治疗组主要采用 BTKi 等口服单药治疗。联合治疗组的总缓解率（ORR）和完全缓解率（CRR）高于单药治疗组（ORR：96% vs. 72%，CRR：92% vs. 63%）。联合治疗组的中位无进展生存期（PFS）也更长（28.8 个月 vs. 13 个月，p=0.012）。然而，联合治疗组的不良反应（3/4 级毒性）发生率高于单药治疗组（45% vs. 8%）。
结论
该研究表明，与单药治疗相比，联合治疗具有更高的 OR 和 CR 率、更长的生存期和更多的毒性。BTKi 抑制剂具有良好的耐受性，但长期疗效仍需前瞻性研究证实。此外，由于原发性 VRL 单药治疗的研究数量较少，还需要更多的研究来验证其疗效。
试验注册
CRD42023400305。
Zotero 插件