Third-generation chemotherapy agents in the treatment of advanced non-small cell lung cancer: A meta-analysis
Third-generation chemotherapy agents in the treatment of advanced non-small cell lung cancer: A meta-analysis
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DOI：
10.1097/jto.0b013e31814617a2
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发表时间：
2007-09-01
影响因子：
20.4
通讯作者：
Socinski, Mark A.
中科院分区：
文献类型：
--
作者：
Baggstrom, Maria Q.;Stinchcombe, Thomas E.;Socinski, Mark A.
目的：评估第三代 (3G) 化疗药物（紫杉醇、多西他赛、吉西他滨、长春瑞滨和伊立替康）对 IIIB/IV 期非小细胞肺癌 (NSCLC) 的反应和生存的疗效。方法：使用通过 MEDLINE 确定的试验进行荟萃分析。肿瘤反应和生存结果来自比较 3G 单药治疗与最佳支持治疗 (BSC)、3G 单药治疗与第二代 (2G) 铂类治疗方案、3G 铂类治疗方案与 2G 铂类治疗方案比较的随机试验。 结果：在筛选的 2480 条引用中，20 项随机对照试验符合纳入和排除标准，19 项试验被使用 在分析中。来自两项、三组试验的数据用于两个不同的比较。五项试验（n = 1029 名患者）比较了 3G 单一疗法与 BSC。 1 年生存率的汇总风险差异 (RD) 有利于 3G 药物 7%（95% 置信区间 [CI]：2%、12%）。四项试验（n = 871 名患者）比较了 3G 单一疗法与 2G 铂类疗法的治疗。缓解 RD 为 - 6% (95% CI: - 11%, 0%)，1 年生存率 RD 为 3% (95% CI: -3%, 10%)，表明尽管 2G 铂类治疗方案的缓解率略高于 3G 单药治疗，但生存率相当。 12 项试验 (n = 3995) 比较了 3G 与 2G 铂类治疗方案。缓解的 RD 为 12%（95% CI：10%、15%）。由于试验之间存在异质性，未计算 1 年的 RD。 3G 与 2G 铂类双药的子集分析显示，I 年生存率 RD 为 6%（95% CI：2%、10%），支持 3G 铂类治疗方案，但没有异质性证据。结论：3G 药物在 NSCLC 治疗中取得了重大进展。
Purpose: To estimate the efficacy of third-generation (3G) chemotherapy agents (paclitaxel, docetaxel, gemcitabine, vinorelbine, and irinotecan) on response and survival in stage IIIB/IV non-small cell lung cancer (NSCLC).Methods: A meta-analysis was performed using trials identified through MEDLINE. Results on tumor response and survival were collected from randomized trials comparing 3G monotherapy versus best supportive care (BSC), 3G monotherapy versus second-generation (2G) platinum-based regimens, and 3G platinum-based regimens versus 2G platinum-based regimens.Results: Of the 2480 citations screened, 20 randomized controlled trials fulfilled the inclusion and exclusion criteria, and 19 trials were used in the analyses. The data from two, three-arm trials were used in two different comparisons. Five trials (n = 1029 patients) compared 3G monotherapy with BSC. The summary risk difference (RD) for 1-year survival favored 3G agents by 7% (95% confidence interval [CI]: 2%, 12%). Four trials (n = 871 patients) compared treatment with 3G monotherapy versus 2G platinum-based regimens. The response RD was - 6% (95 % CI: - 11%, 0%), and the 1-year survival rate RD was 3% (95% CI: -3%, 10%), suggesting that despite a slightly higher response rate for 2G platinum-based regimens relative to 3G monotherapy, there is equivalency in survival. Twelve trials (n = 3995) compared 3G versus 2G platinum-based regimens. The RD for response was 12% (95% CI: 10%, 15%). A RD for 1-year was not calculated, because of heterogeneity among the trials. A subset analysis of 3G versus 2G platinum-based doublets revealed a I-year survival-rate RD of 6% (95% CI: 2%, 10%), favoring 3G platinum-based regimens without evidence of heterogeneity.Conclusions: 3G agents have been a significant advance in the treatment of NSCLC.