曲妥珠单抗、拉帕替尼及二者联合用于乳腺癌新辅助治疗的Meta分析

发布时间：2018-03-01 10:28

  本文关键词： 乳腺癌 新辅助治疗 曲妥珠单抗 拉帕替尼 Meta分析　出处：《新疆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：应用Meta分析的统计学方法比较在HER2阳性乳腺癌中,新辅助化疗分别联合曲妥珠单抗、拉帕替尼、曲妥珠单抗和拉帕替尼双靶向药物三种不同疗法的有效性和安全性。方法：计算机检索PubMed、MEDLINE、The Cochrane Library、Web of science、CNKI、万方数据库,同时手工检索近5年重要国际肿瘤学会议记录,严格按照纳入与排除标准,收集所有比较HER2阳性乳腺癌患者使用新辅助化疗分别联合曲妥珠单抗、拉帕替尼、曲妥珠单抗和拉帕替尼双靶向药物三种不同治疗的有效性和安全性的前瞻性随机对照研究,按Cochrane系统评价方法进行质量评价、资料提取,运用RevMan5.0软件进行Meta分析。结果：最终纳入7项前瞻性随机对照研究,共2227例患者。Meta分析结果显示,拉帕替尼组的pCR率明显低于曲妥珠单抗组[RR=0.80,95%CI (0.70-0.92),P=0.002];而曲妥珠单抗和拉帕替尼两药联合组分别较曲妥珠单抗组、拉帕替尼组相比,pCR率均更高[RR=1.36,95%CI (1.19-1.56), P0.00001和RR=1.64,95%CI (1.28-2.11), P=0.0001]。III-IV度不良反应方面,拉帕替尼组腹泻[RR=6.74,95%CI (4.20-10.82), P0.00001]、皮肤损害[RR=6.42,95%CI (3.20-12.88), P0.00001]及肝脏损害[RR=1.78,95%CI (1.05-3.02),P=0.03]的发生率明显高于曲妥珠单抗组；两药联合组较曲妥珠单抗组相比,除了腹泻[RR=12.20,95%CI (6.36-23.41), P0.00001]和皮肤损害[RR=3.76,95%CI(1.81-7.83),P=0.0004]发生率更高以外,其他均未见明显差别：但两药联合组较拉帕替尼组相比,并未增加患者不良反应发生率,相反,其在Ⅲ-Ⅳ度充血性心力衰竭方面反而明显低于拉帕替组[RR=0.21, 95%CI(0.05-0.82), P=0.02]结论：在HER2阳性乳腺癌新辅助治疗中,拉帕替尼的有效性和安全性均低于曲妥珠单抗；曲妥珠单抗、拉帕替尼联合的双靶向治疗较单一靶向治疗有效性更高,同时安全性也尚可。
[Abstract]:Objective: to compare the effects of neo-adjuvant chemotherapy combined with tratozumab and Rapatinib in HER2 positive breast cancer by Meta analysis. The efficacy and safety of three different therapies, Tratozumab and Rapatini, were studied. Methods: the Cochrane MEDLINE of the Cochrane Library of CNKI, the Wanfang database, and the records of the recent five important international oncology conferences were searched by computer. According to the inclusion and exclusion criteria, all patients with HER2 positive breast cancer received neoadjuvant chemotherapy combined with tratozumab and Rapatini respectively. A prospective randomized controlled study of the efficacy and safety of tratozumab and Rapatinib in the treatment of three different therapies was conducted. The quality was evaluated by Cochrane system and the data were extracted. Results: 7 prospective randomized controlled trials were conducted with RevMan5.0 software. Results: a total of 2227 patients were analyzed by Meta-analysis. The pCR rate of the labatinib group was significantly lower than that of the trapezumab group [RRX 0.8095 [CI 0.70-0.92P0. 002], while that of the tratozumab and lapatinib groups was higher than that of the trapezumab group [RR1.36-9595CI 1.19-1.56, P0.00001 and RR1.6495CI 1.28-2.1111, P0.0001]. The incidence of diarrhoea [RRN 6.74-95CI 4.20-10.82, P0.00001], skin damage [RRR6.4295 CI 3.20-12.88, P0.00001] and liver damage [RRR1.78-95CI 1.05-3.02P0.03] was significantly higher than that of trotozumab group; the incidence of diarrhea [RR12.20 ~ 95CI 6.36-23.41, P0.00001] and skin damage [RRRN 3.79695 CI 1.81-7.83P0. 0004] was significantly higher in the combined group than that in the trotozumab group, with the exception of diarrhea [RRR12.20 ~ 95CI 6.36-23.41, P0.00001] and skin damage [RRN 3.7695 CI 1.81-7.83P0. 0004]. There was no significant difference between the two groups. However, the incidence of adverse reactions was not increased in the combination group compared with that in the Rapatini group, but on the contrary, there was no significant difference between the two groups. It was significantly lower in 鈪，

本文编号：1551526