Second- and third-line systemic therapy in patients with advanced esophagogastric cancer: a systematic review of the literature.
Second- and third-line systemic therapy in patients with advanced esophagogastric cancer: a systematic review of the literature.
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DOI：
10.1007/s10555-016-9632-2
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发表时间：
2016-09
影响因子：
9.2
通讯作者：
van Laarhoven, Hanneke W. M.
中科院分区：
文献类型：
--
作者：
ter Veer, Emil;Mohammad, Nadia Haj;van Valkenhoef, Gert;Ngai, Lok Lam;Mali, Rosa M. A.;van Oijen, Martijn G. H.;van Laarhoven, Hanneke W. M.
对于晚期食管胃癌患者的最佳二线和三线化疗及靶向治疗仍然是一个争论的问题。因此，在Medline、EMBASE、CENTRAL和肿瘤学会议中进行了文献检索，直至2016年1月，以查找比较二线或三线治疗的随机对照试验。我们纳入了28项研究，4810例患者。与最佳支持治疗（BSC）相比，紫杉烷/伊立替康二线单药治疗显示生存期延长（风险比0.65，95%置信区间0.53-0.79）。个别研究的中位生存期增加范围为1.4至2.7个月。紫杉烷和伊立替康为基础的方案显示出相同的生存获益。紫杉烷/伊立替康+铂和氟嘧啶的双联化疗在生存期方面没有差异，但与紫杉烷/伊立替康单药治疗相比，毒性增加。与BSC相比，二线ramucirumab和二线或三线依维莫司和瑞戈非尼显示出有限的中位生存期增加，范围为1.1至1.4个月，无进展生存期增加，范围为0.3至1.6个月。与BSC相比，三线或更高线阿帕替尼显示生存获益增加（HR 0.50，0.32-0.79）。中位生存期增加范围为1.8至2.3个月。与单独使用紫杉烷相比，二线雷莫芦单抗加紫杉烷（HR 0.81，0.68-0.96）和奥拉帕尼加紫杉烷（HR 0.56，0.35-0.87）的生存率更高，中位生存期分别为2.2和4.8个月。上级。靶向药物，无论是在单药治疗或联合化疗显示增加的毒性相比，BSC和化疗单独。该综述表明，鉴于III期研究环境中的生存获益，雷莫芦单抗加紫杉烷是首选的二线治疗。紫杉烷或伊立替康单药治疗是替代方案，尽管绝对生存获益有限。在三线治疗中，首选阿帕替尼单药治疗。
The optimal second- and third-line chemotherapy and targeted therapy for patients with advanced esophagogastric cancer is still a matter of debate. Therefore, a literature search was carried out in Medline, EMBASE, CENTRAL, and oncology conferences until January 2016 for randomized controlled trials that compared second- or third-line therapy. We included 28 studies with 4810 patients. Second-line, single-agent taxane/irinotecan showed increased survival compared to best supportive care (BSC) (hazard ratio 0.65, 95 % confidence interval 0.53–0.79). Median survival gain ranged from 1.4 to 2.7 months among individual studies. Taxane- and irinotecan-based regimens showed equal survival benefit. Doublet chemotherapy taxane/irinotecan plus platinum and fluoropyrimidine was not different in survival, but showed increased toxicity vs. taxane/irinotecan monotherapy. Compared to BSC, second-line ramucirumab and second- or third-line everolimus and regorafenib showed limited median survival gain ranging from 1.1 to 1.4 months, and progression-free survival gain, ranging from 0.3 to 1.6 months. Third- or later-line apatinib showed increased survival benefit over BSC (HR 0.50, 0.32–0.79). Median survival gain ranged from 1.8 to 2.3 months. Compared to taxane-alone, survival was superior for second-line ramucirumab plus taxane (HR 0.81, 0.68–0.96), and olaparib plus taxane (HR 0.56, 0.35–0.87), with median survival gains of 2.2 and 4.8 months respectively. Targeted agents, either in monotherapy or combined with chemotherapy showed increased toxicity compared to BSC and chemotherapy-alone. This review indicates that, given the survival benefit in a phase III study setting, ramucirumab plus taxane is the preferred second-line treatment. Taxane or irinotecan monotherapy are alternatives, although the absolute survival benefit was limited. In third-line setting, apatinib monotherapy is preferred.
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影响因子：
51.1
作者：
Ford, Hugo E. R.;Marshall, Andrea;Dunn, Janet A.
通讯作者：
Dunn, Janet A.
影响因子：
8.8
作者：
Janowitz T;Thuss-Patience P;Marshall A;Kang JH;Connell C;Cook N;Dunn J;Park SH;Ford H
通讯作者：
Ford H
影响因子：
8.4
作者：
Nishikawa, Kazuhiro;Fujitani, Kazumasa;Tsujinaka, Toshimasa
通讯作者：
Tsujinaka, Toshimasa
影响因子：
50.5
作者：
Kim, H. S.;Kim, H. J.;Zang, D. Y.
通讯作者：
Zang, D. Y.
影响因子：
168.9
作者：
Fuchs, Charles S.;Tomasek, Jiri;Tabernero, Josep
通讯作者：
Tabernero, Josep