Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis.
Efficacy and Safety of First-Line Chemotherapies for Patients With Advanced Biliary Tract Carcinoma: A Systematic Review and Network Meta-Analysis.
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一线化学疗法对晚期胆道癌患者的功效和安全性：系统的综述和网络荟萃分析。
DOI：
10.3389/fonc.2021.736113
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发表时间：
2021
影响因子：
4.7
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Jiang Y;Zeng Z;Zeng J;Liu C;Qiu J;Li Y;Tang J;Mo N;Du L;Ma J
目前，化疗仍是晚期胆道癌的主要治疗手段，但如何平衡疗效和毒副作用仍是一个挑战。网络荟萃分析（NMA）是一种较好的方案识别方法，其优点是可以结合直接和间接证据来判断最佳治疗方案。因此，我们对检索到的随机对照试验（RCT）进行了NMA。通过比较不同化疗方案的无进展生存期（PFS）、总生存期（OS）、客观缓解率（ORR）和不良事件（AE），对检索到的RCT进行NMA。我们筛选了24项符合纳入标准的研究进行进一步分析。与其他方案相比，最佳支持治疗（BSC）或FUFA方案的OS较差。Folfox4、GEMOX+厄洛替尼、C+GEMOX与BSC相比，可改善患者的PFS。接受GP+西地尼布方案的患者具有更高的ORR。GP+西地尼布、GS、C+GEMOX、RAM+GP、MER+GP方案组≥3级中性粒细胞减少率均低于FUFA方案组。与GEM+ XinjiX相比，XinjiX的呕吐概率较低。与GEMOX+厄洛替尼组相比，XEMOX组的腹泻发生率较低。聚类等级分析结果表明，GEMOX+厄洛替尼在中性粒细胞减少和呕吐的累积排序（SUCRA）下具有较高的ORR和较高的表面积，但腹泻和疲乏的SUCRA也较低。同时，GEMOX和C+GEMOX均具有更好的ORR和更高的AE SUCRA。NMA证明，化疗联合靶向治疗比单独化疗具有更好的疗效和更低的AE发生率。
At present, chemotherapy is still the primary treatment for advanced biliary tract carcinoma, but it is challenging to balance the efficacy and side effects. Network meta-analysis (NMA) is a better way to identify the protocol, and the advantage is that it can be combined with direct and indirect evidence to judge the best treatment regimens. Therefore, we conducted NMA on the searched randomized controlled trials (RCTs). NMA was conducted regarding the searched RCTs by comparing progression-free survival (PFS), overall survival (OS), objective remission rates (ORRs), and adverse events (AEs) of different chemotherapy protocols. We screened 24 studies that met the inclusion criteria for further analysis. Compared with other regimens, the best supportive care (BSC) or FUFA protocol has a worse OS. Folfox4, GEMOX+erlotinib, and C+GEMOX can improve patients’ PFS compared with BSC. Patients receiving GP+cediranib protocol have higher ORRs. There was reduced neutropenia grade ≥3 when adopting GP+cediranib, GS, C+GEMOX, RAM+GP, and MER+GP than when using FUFA protocol. The probability of vomiting of XELOX is lower than that of GEM+XELOX. There is a lower diarrhea incidence of XELOX than that of GEMOX+erlotinib. The results of cluster grade analysis illustrated that GEMOX+erlotinib owned a higher ORR and a higher surface under the cumulative ranking (SUCRA) of neutropenia and vomiting but also had a lower SUCRA of diarrhea and fatigue. Meanwhile, both GEMOX and C+GEMOX have a better ORR and a higher AE SUCRA. The NMA demonstrated that chemotherapy combined with targeted therapy has better efficacy and lower incidence of AEs than chemotherapy alone.
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