Algoma District Cancer Program, Sault Area Hospital, Sault Ste Marie, Ontario, Canada; Division of Clinical Sciences, Section of Internal Medicine, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Department of Internal Medicine, Oncology Unit, Ippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Clin Colorectal Cancer. 2024 Dec;23(4):318-325.e1. doi: 10.1016/j.clcc.2024.05.009. Epub 2024 Jun 3.
Biliary tract carcinomas are cancers that, despite a lower prevalence compared with other gastrointestinal cancers, represent a significant public health burden due to their aggressiveness. The metastatic stage of the disease is highly lethal and difficult to treat. Options of systemic therapies, especially beyond the first line are few and less well established.
We performed a systematic review of literature databases to identify studies of the combination of irinotecan and 5-fluorouracil (5-FU) based chemotherapy as treatment of metastatic biliary tract carcinomas in second line, after first line treatment with platinum/gemcitabine chemotherapy. Both prospective and retrospective designs were admissible. A meta-analysis of identified studies to determine summary estimates for overall response rate (ORR), disease control rate (DCR), progression free survival (PFS) and overall survival (OS) was also performed.
The search was performed in PubMed/Medline and in Embase databases and identified a total of 339 articles. Manual review resulted in 8 articles that were eligible for inclusion in the meta-analysis. Second line irinotecan/5-FU based combinations produced an ORR of 9.1% (95% CI, 5.5%-12.6%) and DCR of 43.3% (95% CI, 15.8%-70.8%). Summary PFS and OS were 2.7 months (95% CI, 2.3-3.1 months) and 6.8 months (95% CI, 5.6-8.0 months), respectively. Treatments appeared to be feasible with adverse effect profiles as expected from the combination.
A moderate activity of second line irinotecan/5-FU based chemotherapy was observed in this meta-analysis. The combination is an option for patients progressing on platinum/gemcitabine chemotherapy, who maintain a sufficient general status to receive active therapy. This combination may also serve as the control arm of second line trials with new targeted agents.
与其他胃肠道癌症相比，胆道癌的发病率较低，但由于其侵袭性，仍给公众健康带来了巨大负担。该疾病的转移阶段具有高度致命性且难以治疗。除一线治疗之外，可供选择的系统治疗方案，特别是二线治疗方案较少且尚未得到充分确立。
我们对文献数据库进行了系统回顾，以确定二线治疗铂类/吉西他滨化疗后转移性胆道癌采用伊立替康联合氟尿嘧啶（5-FU）化疗方案的研究。可接受前瞻性和回顾性设计。还对确定的研究进行了荟萃分析，以确定总缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）和总生存期（OS）的汇总估计值。
在 PubMed/Medline 和 Embase 数据库中进行了检索，共检索到 339 篇文章。手动审查后，有 8 篇文章符合纳入荟萃分析的条件。二线伊立替康/5-FU 联合方案的 ORR 为 9.1%（95%CI，5.5%-12.6%），DCR 为 43.3%（95%CI，15.8%-70.8%）。汇总的 PFS 和 OS 分别为 2.7 个月（95%CI，2.3-3.1 个月）和 6.8 个月（95%CI，5.6-8.0 个月）。该治疗方案的不良反应与预期的联合治疗相符，具有可行性。
在这项荟萃分析中，二线伊立替康/5-FU 联合化疗显示出中等活性。对于铂类/吉西他滨化疗进展的患者，如果其一般状况仍足以接受积极治疗，该联合方案是一种选择。该联合方案也可作为二线治疗新靶向药物试验的对照。
