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中国癌症防治杂志

中国癌症防治杂志 ›› 2018, Vol. 10 ›› Issue (3): 229-234.doi: 10.3969/j.issn.1674-5671.2018.03.14

• 循证医学 • 上一篇    下一篇

含贝伐珠单抗维持治疗晚期结直肠癌患者疗效与安全性的Meta分析

  

  1. 广西医科大学附属肿瘤医院化疗一科；广西医科大学研究生院
  • 出版日期:2018-06-25 发布日期:2018-07-02
  • 通讯作者: 李永强 E-mail:lyq702702@126.com

Meta-analysis of efficacy and safety of bevacizumab-based maintenance therapy in patients with advanced colorectal cancer

  • Online:2018-06-25 Published:2018-07-02

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摘要：

目的 系统评价含贝伐珠单抗不同联合方案治疗晚期结直肠癌的疗效与安全性。方法 计算机检索PubMed、EMbase、Web of Science、Cochrane Library 数据库截至2017年7月31日有关贝伐珠单抗维持治疗晚期结直肠癌的随机对照试验。按纳入排除标准筛选文献、资料提取和评价质量，采用RevMan 5.3 软件进行Meta 分析。 结果 共纳入8项研究，2 644例晚期结直肠癌患者。Meta分析显示，贝伐珠单抗维持治疗组（包括单药和联合化疗）前者无疾病进展生存期（PFS）和总生存期（OS）均优于无治疗组（HR=0.65，95% CI：0.53~0.78，P<0.001；HR=0.83，95% CI：0.71~0.98，P=0.020），但前者3~4级感觉神经障碍及高血压发生率高于后者（P=0.001，0.008）。贝伐珠单抗维持治疗组与持续治疗组对比，两者的PFS和OS相当（HR=1.05，95% CI：0.56~1.71，P=0.830；HR=1.11，95% CI：0.92~1.35，P=0.270），而后者3~4级感觉神经障碍、疲乏和手足综合征明显高于前者（P＜0.001，0.020，0.040）。与单药贝伐珠单抗组比较，贝伐珠单抗抗抗联合厄洛替尼组能改善PFS和OS（HR=0.81，95% CI：0.67~0.96，P=0.020；HR=0.81，95% CI：0.67~0.99，P=0.040），但贝伐珠单联合厄洛替尼组3~4级皮疹发生率明显高于单药贝伐珠单抗组（P<0.001）。结论 贝伐珠单抗单药、联合低毒化疗药物或厄洛替尼，均可改善晚期结直肠癌患者PFS和OS，患者可耐受，贝伐珠单抗维持治疗可作为晚期结直肠癌维持阶段的优选治疗方案。

关键词: 晚期结直肠癌, 贝伐珠单抗, 维持治疗, 疗效, 安全性, Meta分析

Abstract:

Objective  To evaluate systematically the efficacy and safety of different bevacizumab-based maintenance strategies in patients with advanced colorectal cancer. Methods The databases PubMed，EMbase，Web of Science，and Cochrane Library were searched for randomized controlled trials published before July 31，2017 involving bevacizumab-based maintenance treatment of advanced colorectal cancer. Data from included studies were extracted，studies were evaluated for quality using the Jadad score，and data were analyzed statistically using RevMan 5.3. Results In the end，eight trials involving 2，644 patients were included in the analysis. Relative to no treatment （NT），bevacizumab-based maintenance therapy （MT；bevacizumab without or with chemotherapy） was associated with significant improvement in progression-free survival（HR＝0.65，95%CI：0.53-0.78，P<0.001） and overall survival（HR＝0.83，95%CI：0.71-0.98，P=0.020）. At the same time，MT was associated with more frequent grade 3/4 sensory neuropathy（P=0.001） and hypertension （P=0.008）. MT and continuous therapy（CT） were associated with similar PFS （HR＝1.05，95%CI：0.56-1.71，P=0.830） and OS （HR＝1.11，95%CI：0.92-1.35，P=0.270）. CT was associated with higher frequency of grade 3/4 sensory neuropathy （P<0.001），fatigue （P=0.020） and hand-foot skin syndrome （P=0.040）. Compared with the group receiving bevacizumab alone，the group receiving bevacizumab plus erlotinib showed better PFS （HR＝0.81，95%CI：0.67-0.96，P=0.020） and OS （HR＝0.81，95%CI：0.67-0.99，P=0.040），albeit with higher incidence of grade 3-4 skin rash（P<0.001）. Conclusions Bevacizumab alone or combined with chemotherapy or erlotinib can significantly improve PFS and OS in patients with advanced colorectal cancer，and most patients tolerate the regimen. Bevacizumab-based maintenance therapy can be recommended as an optimal regimen during the maintenance stage.

Key words: Advanced colorectal cancer, Bevacizumab, Maintenance therapy, Efficacy, Safety, Meta-analysis