Inhibition of the VEGF/VEGFR Pathway Improves Survival in Advanced Kidney Cancer: A Systematic Review and Meta-Analysis
Inhibition of the VEGF/VEGFR Pathway Improves Survival in Advanced Kidney Cancer: A Systematic Review and Meta-Analysis
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DOI：
10.2174/1389450115666141120120145
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发表时间：
2015-01-01
影响因子：
3.2
通讯作者：
Procopio, Giuseppe
中科院分区：
文献类型：
--
作者：
Iacovelli, Roberto;Sternberg, Cora N.;Procopio, Giuseppe
尽管无进展生存率和缓解率有所改善，但用于治疗转移性肾细胞癌（mRCC）的5种抗VEGF/VEGFR药物均未报告患者生存率显著增加。本分析旨在研究其对总生存期（OS）的影响，对现有研究进行荟萃分析。在MEDLINE/PubMed和科克伦图书馆中检索比较抗VEGF/VEGFR药物与对照药物作为mRCC前期治疗的随机III期试验。检索仅限于III期试验，并根据PRISMA声明进行数据提取。纳入了5项随机III期试验，共纳入3，469例患者;其中1，801例接受抗VEGF/VEGFR药物治疗，1，668例接受安慰剂或干扰素α治疗。在总体人群中，死亡风险降低13%（HR：0.87; 95%CI，0.80 - 0.95; p=0.002）。当根据使用VEGFR药物或抗VEGF单克隆抗体对患者进行分类时，死亡风险分别降低了13%和12%。如果仅考虑初治患者，我们可以证实死亡风险显著降低12%（HR=0.88; 95%CI，0.79 - 0.97; p=0.010）。我们的分析报告了mRCC中VEGF/VEGFR通路的抑制对OS的积极改善。
Despite the improvement in progression-free survival and response rates, none of the five anti-VEGF/VEGFR agents used for treatment of metastatic renal cell carcinoma (mRCC) reported a significant increase in patients' survival. This analysis aims to investigate their effect on overall survival (OS), performing a meta-analysis of the available studies. MEDLINE/PubMed and the Cochrane Library were searched for randomised phase III trials that compared anti-VEGF/VEGFR agents with controls as upfront treatment for mRCC. The search was restricted to phase III trials, and data extraction was conducted according to the PRISMA statement. Five randomised phase III trials were included for a total of 3,469 patients; among these, 1,801 received anti-VEGF/VEGFR agents and 1,668 were treated with a placebo or interferon-alpha. In the overall population, the reduction in the risk of death was 13% (HR: 0.87; 95%CI, 0.80 - 0.95; p=0.002). When patients were divided based on use of VEGFR agents or an anti-VEGF monoclonal antibody, the reduction in the risk of death was 13% and 12%, respectively. If only treatment-naive patients are considered, we can confirm a significant reduction of 12% (HR=0.88; 95%CI, 0.79 - 0.97; p=0.010) in the risk of death. Our analysis reports a positive improvement of OS with the inhibition of the VEGF/VEGFR pathway in mRCC.