Interventions for preventing neuropathy caused by cisplatin and related compounds.
Interventions for preventing neuropathy caused by cisplatin and related compounds.
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DOI：
10.1002/14651858.cd005228.pub3
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发表时间：
2011-02-16
影响因子：
8.4
通讯作者：
Donehower, Ross C.
中科院分区：
文献类型：
--
作者：
Albers, James W.;Chaudhry, Vinay;Cavaletti, Guido;Donehower, Ross C.
关键词：
Adrenocorticotropic Hormone [analogs & derivatives ; therapeutic use]Amifostine [therapeutic use]Antineoplastic Agents [adverse effects]Cisplatin [adverse effects ; analogs & derivatives]Ditiocarb [therapeutic use]Glutathione [therapeutic use]Neuroprotective Agents [therapeutic use]Peptide Fragments [therapeutic use]Peripheral Nervous System Diseases [chemically induced ; prevention & control]Randomized Controlled Trials as TopicVitamin E [therapeutic use]Humans
用于治疗多种类型实体瘤的顺铂和几种相关抗肿瘤药物具有神经毒性，大多数完成顺铂化疗全程的患者会出现临床可检测到的感觉神经病。人们一直在寻找有效的神经保护疗法。检查所谓的化学保护剂预防或限制顺铂及相关药物的神经毒性的功效。我们检索了Cochrane神经肌肉疾病组专业注册库（2010年8月25日）、Cochrane对照试验中央注册库（Cochrane图书馆2010年第3期）、MEDLINE（1966年1月至2010年8月）、EMBASE（1980年1月至2010年8月）、LILACS（1982年1月至8月） 2010），CINAHL（1982年1月至2010年8月）用于评估用于预防或限制神经保护剂的随机试验 顺铂和相关药物对人类患者的神经毒性。准随机或随机对照试验，参与者接受顺铂（或相关化合物）化疗，联合或不联合潜在化学保护剂（乙酰半胱氨酸、氨磷汀、ACTH、BNP7787、钙和镁、二乙基二硫代氨基甲酸盐、谷胱甘肽、Org 2766、奥卡西平或维生素 E）并进行评估 完成化疗后零到六个月，使用定量感觉测试（主要）或其他措施，包括神经传导研究或使用经过验证的量表进行神经损伤评级（次要）。在 2006 年的初步审查中，我们确定了 16 项随机试验，涉及五种可能的化学保护剂。每项研究均由两位作者审查，他们提取数据并达成共识。 2010 年更新确定了另外 11 项随机试验，其中包括 9 种可能的化学保护剂，其中包括 2006 年综述中未描述的三种治疗方法（乙酰半胱氨酸、钙和镁以及奥卡西平）。更新的综述中纳入的试验涉及八种不相关的治疗方法，并包括许多不同的神经病变测量方法，导致任何一项测量数据都不足以合并大多数情况下的结果。四项符合条件的氨磷汀试验（所有四项试验共有 541 名受试者）中的一项使用了定量感官测试，并在氨磷汀神经保护方面表现出良好的结果，但振动感知阈值结果仅基于 14 名接受氨磷汀治疗的受试者的数据，这些受试者完成了治疗后评估，应谨慎对待。在六项符合条件的谷胱甘肽试验（354 名受试者）中，一项使用了定量感官测试，但仅报告了定性分析。四项合格的 Org 2766 试验（311 名受试者）采用定量感官测试，报告了不同的结果；使用可比措施对三项试验进行的荟萃分析显示，振动感知阈值没有显着的神经保护作用。其余试验仅报告描述性分析。涉及乙酰半胱氨酸（14 名受试者）、二乙基二硫代氨基甲酸酯（195 名受试者）、钙和镁（33 名受试者）和奥卡西平（32 名受试者）的单个合格试验以及涉及维生素 E（57 名受试者）的两项合格试验没有进行定量感官测试。总共包含 1,537 名参与者的数据。目前，数据不足以得出任何所谓的化学保护剂（乙酰半胱氨酸、氨磷汀、钙和镁、二乙基二硫代氨基甲酸盐、谷胱甘肽、Org 2766、奥卡西平或维生素 E）可以预防或限制铂类药物对人类患者的神经毒性的结论。
Cisplatin and several related antineoplastic agents used to treat many types of solid tumors are neurotoxic, and most patients completing a full course of cisplatin chemotherapy develop a clinically detectable sensory neuropathy. Effective neuroprotective therapies have been sought. To examine the efficacy of purported chemoprotective agents to prevent or limit the neurotoxicity of cisplatin and related agents. We searched the Cochrane Neuromuscular Disease Group Specialized Register (25 August 2010), the Cochrane Central Register of Controlled Trials (Issue 3, 2010 in The Cochrane Library), MEDLINE (January 1966 to August 2010), EMBASE (January 1980 to August 2010), LILACS (January 1982 to August 2010), CINAHL (January 1982 to August 2010) for randomized trials designed to evaluate neuroprotective agents used to prevent or limit neurotoxicity of cisplatin and related agents among human patients. Quasi-randomized or randomized controlled trials whose participants received cisplatin (or related compounds) chemotherapy with or without a potential chemoprotectant (acetylcysteine, amifostine, ACTH, BNP7787, calcium and magnesium, diethyldithiocarbamate, glutathione, Org 2766, oxcarbazepine, or vitamin E) and were evaluated zero to six months after completing chemotherapy using quantitative sensory testing (primary) or other measures including nerve conduction studies or neurological impairment rating using validated scales (secondary). We identified 16 randomized trials involving five possible chemoprotective agents in the initial 2006 review. Each study was reviewed by two authors who extracted the data and reached consensus. The 2010 update identified 11 additional randomized trials consisting of nine possible chemoprotective agents, including three treatments (acetylcysteine, calcium and magnesium, and oxcarbazepine) not among those described in the 2006 review. The included trials in the updated review involved eight unrelated treatments and included many disparate measures of neuropathy, resulting in insufficient data for any one measure to combine the results in most instances. One of four eligible amifostine trials (541 total participants in all four trials) used quantitative sensory testing and demonstrated a favorable outcome in terms of amifostine neuroprotection, but the vibration perception threshold result was based on data from only 14 participants receiving amifostine who completed the post-treatment evaluation and should be regarded with caution. Of the six eligible glutathione trials (354 participants), one used quantitative sensory testing but reported only qualitative analyses. Four eligible Org 2766 trials (311 participants) employed quantitative sensory testing reported disparate results; meta-analyses of three trials using comparable measures showed no significant vibration perception threshold neuroprotection. The remaining trial reported only descriptive analyses. The single eligible trials involving acetylcysteine (14 participants), diethyldithiocarbamate (195 participants), calcium and magnesium (33 participants), and oxcarbazepine (32 participants) and the two eligible trials involving vitamin E (57 participants) did not perform quantitative sensory testing. In all, data from 1,537 participants were included. At present, the data are insufficient to conclude that any of the purported chemoprotective agents (acetylcysteine, amifostine, calcium and magnesium, diethyldithiocarbamate, glutathione, Org 2766, oxycarbazepine, or Vitamin E) prevent or limit the neurotoxicity of platin drugs among human patients.