Chemotherapy for advanced biliary tract carcinoma A meta-analysis of randomized controlled trials
Chemotherapy for advanced biliary tract carcinoma A meta-analysis of randomized controlled trials
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DOI：
10.1097/md.0000000000004584
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发表时间：
2016-08-01
期刊：
影响因子：
1.6
通讯作者：
Tam, Ka-Wai
中科院分区：
文献类型：
--
作者：
Chen, Lawrence;Chen, Chiehfeng;Tam, Ka-Wai
背景：虽然吉西他滨和铂类药物(GP)目前被认为是晚期胆道癌的标准化疗方案，但预后仍然很差。与氟嘧啶类药物和靶向治疗的联合治疗显示出不大的好处。因此，我们进行了一项随机对照试验的荟萃分析，以评价不同化疗方案的疗效。方法：PubMed、EMBASE、Cochrane Library、Scope us和临床试验。在GOV注册表上搜索到2016年4月之前发表的研究。采用Meta分析方法，利用随机效应模型计算合并效应大小。治疗效果用无进展生存期(PFS)和总生存期来衡量。次要结果包括客观应答率(ORR)、1年生存率、生活质量、疾病控制率和不良事件。结果：15项试验涉及1775名患者。在接受标准GP化疗的同时，接受表皮生长因子受体(EGFR)靶向治疗的患者的中位PFS(加权平均差值=-1.49；95%可信区间-2.56至-0.43)、PFS(危险比=0.79；95%可信区间0.63~0.99)和ORR(优势比=0.56；95%可信区间0.38~0.82)显著增加。联合应用GP、氟嘧啶类药物或血管EGFR抑制剂(VEGFR)并不能改善患者的预后。结论：将EGFR靶向治疗与目前标准的GP化疗相结合是一种安全可行的选择，可以改善晚期BTC患者的中位PFS、PFS和ORR。有必要进一步研究针对特定BTC患者群体的EGFR抑制剂的最佳剂量和药物类型。
Background: Although gemcitabine and platinum-based agents (GP) are currently regarded as the standard chemotherapy for advanced biliary tract cancer (BTC), the prognosis remains poor. Combinations with fluoropyrimidines and targeted therapy have demonstrated modest benefits. Therefore, we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy of different chemotherapy regimens.Methods: The PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials. gov registries were searched for studies published until April 2016. A meta-analysis was conducted to calculate the pooled effect size by using random effects models. Treatment efficacies were measured using progression-free survival (PFS) and overall survival. The secondary outcomes included the objective response rate (ORR), 1-year survival rate, quality of life, disease control rate, and adverse events.Results: Fifteen trials that involved examining 1775 patients were reviewed. Patients who received epidermal growth factor receptor (EGFR)-targeted therapy in addition to standard GP chemotherapy exhibited a significantly higher median PFS (weighted mean difference =-1.49; 95% confidence interval -2.56 to -0.43), PFS (hazard ratio = 0.79; 95% confidence interval 0.63-0.99), and ORR (odd ratio = 0.56; 95% confidence interval 0.38-0.82). Combining GP with fluoropyrimidines or vascular EGFR inhibitors (VEGFR) did not improve patient outcomes.Conclusion: Combining EGFR-targeted therapy with the current standard GP chemotherapy is a safe and viable option that may improve the median PFS, PFS, and ORR in patients with advanced BTC. Further research investigating the optimal dosage and drug type of EGFR inhibitors for specific BTC patient groups is warranted.