Wang Wei, Liu Fayong, Qiu Shan, Jiao Yan, Zhu Yan
Department of Obstetrics and Gynecology, Xiantao Maternal and Child Health Hospital, Xiantao, Hubei 433000, P.R. China.
Department of Obstetrics and Gynecology, Maternity Hospital of Diarete Province, Diarete, Diarete 14000, Algeria.
Exp Ther Med. 2024 Jul 26;28(4):376. doi: 10.3892/etm.2024.12665. eCollection 2024 Oct.
At present, the optimal therapeutic approach for the treatment of platinum-resistant recurrent ovarian cancer remains to be fully elucidated. The present systematic review and network meta-analysis aimed to elucidate the relative efficacy and safety of apatinib, administered either as monotherapy or in conjunction with chemotherapy, compared with chemotherapy alone, for the treatment of platinum-resistant recurrent ovarian cancer. The PubMed, Embase and Wanfang Data electronic databases were searched, where the search spanned from the conception of the databases until April 2023. A quality evaluation was conducted and R software was used for network meta-analysis. Following inclusion and exclusion criteria screening, the present analysis included 17 clinical trials, combining data from 1,228 patients with platinum-resistant recurrent ovarian cancer categorized into the following three treatment cohorts: i) 555 patients who received apatinib plus chemotherapy; ii) 229 patients who received apatinib alone; and iii) 444 patients who underwent conventional chemotherapy. Results of the present study demonstrated that the co-administration of apatinib with either tegiol [odds ratio (OR), 2.54; 95% CI, 1.06-6.11] or etoposide (OR, 2.12; 95% CI, 1.20-3.74) significantly improved the objective response rate (ORR) compared with that following apatinib monotherapy. By contrast, gemcitabine monotherapy resulted in inferior ORR efficacy compared with that following apatinib (OR, 0.47; 95% CI, 0.23-0.95). In addition, combinations of apatinib with etoposide (OR, 1.32; 95% CI, 1.06-1.64) or paclitaxel (OR, 1.52; 95% CI, 1.04-2.23) demonstrated a significantly improved disease control rates (DCR) compared with those following apatinib alone. According to the area under the cumulative ranking analysis, apatinib and paclitaxel in combination was the most efficacious treatment modality in terms of DCR. In terms of safety, the incidence of adverse events, such as hand-foot syndrome [relative risk (RR), 4.23; 95% CI, 1.80-9.95] and hypertension (RR, 4.80; 95% CI, 1.53-15.05), was found to be significantly higher in patients treated with apatinib-containing therapies, compared with those treated with chemotherapy alone. Consequently, the present meta-analysis highlighted the potential of apatinib, particularly in combination with chemotherapy, as a therapeutic strategy for patients with platinum-resistant recurrent ovarian cancer.
目前，铂耐药复发性卵巢癌的最佳治疗方法仍有待充分阐明。本系统评价和网络荟萃分析旨在阐明阿帕替尼单药治疗或与化疗联合使用与单纯化疗相比，治疗铂耐药复发性卵巢癌的相对疗效和安全性。检索了PubMed、Embase和万方数据电子数据库，检索时间跨度从数据库建立至2023年4月。进行了质量评估，并使用R软件进行网络荟萃分析。经过纳入和排除标准筛选，本分析纳入了17项临床试验，合并了1228例铂耐药复发性卵巢癌患者的数据，分为以下三个治疗队列：i）555例接受阿帕替尼加化疗的患者；ii）229例单独接受阿帕替尼治疗的患者；iii）444例接受传统化疗的患者。本研究结果表明，阿帕替尼与替吉奥联合使用（比值比（OR），2.54；95%置信区间，1.06 - 6.11）或与依托泊苷联合使用（OR，2.12；95%置信区间，1.20 - 3.74）与阿帕替尼单药治疗相比，显著提高了客观缓解率（ORR）。相比之下，吉西他滨单药治疗的ORR疗效低于阿帕替尼（OR，0.47；95%置信区间，0.23 - 0.95）。此外，阿帕替尼与依托泊苷联合使用（OR，1.32；95%置信区间，1.06 - 1.64）或与紫杉醇联合使用（OR，1.52；95%置信区间，1.04 - 2.23）与单独使用阿帕替尼相比，疾病控制率（DCR）显著提高。根据累积排名分析曲线下面积，就DCR而言，阿帕替尼与紫杉醇联合使用是最有效的治疗方式。在安全性方面，与单纯化疗的患者相比，接受含阿帕替尼治疗的患者手足综合征（相对风险（RR），4.23；95%置信区间，1.80 - 9.95）和高血压（RR，4.80；95%置信区间，1.53 - 15.05）等不良事件的发生率显著更高。因此，本荟萃分析强调了阿帕替尼的潜力，特别是与化疗联合使用时，作为铂耐药复发性卵巢癌患者的一种治疗策略。
