EGFR-TKI与多西他赛二线治疗非小细胞肺癌有效性与安全性的meta分析

发布时间：2018-03-06 19:45

本文选题：吉非替尼　切入点：厄洛替尼　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:采用系统评价的方法,对表皮生长因子受体酪氨酸激酶抑制剂(吉非替尼或者厄洛替尼)和多西他赛用于晚期非小细胞肺癌患者二线治疗的治疗效果以及其安全性进行对比。方法:检索PUBMED、Cochrane Library、Embase、CNKI、万方、维普等数据库,收集1995年1月至2015年3月间,与表皮生长因子受体酪氨酸激酶抑制剂对比多西他赛二线治疗晚期非小细胞肺癌有关的临床随机对照试验(RTC),2名独立研究员根据纳入与排除标准筛选文献,进行文献质量评价,计算风险比(HR)值、相对危险度(RR)值以及他们各自的95%可信区间(CI),所有数据均采用Review Manager 5.3.0软件进行统计学分析。结果:6篇符合条件的临床随机对照试验(RTC)被此次meta分析所采用,总计纳入2747例一线治疗失败的非小细胞肺癌患者,其中1389例患者接受EGFR-TKI治疗,1358例患者接受多西他赛治疗。Meta分析结果显示EGFR-TKI与多西他赛相比,两组患者总生存期的差异(HR=1.05,95%CI=0.96~1.14,Z=0.97,P=0.33)无显著统计学意义。多西他赛治疗组患者的无进展生存期较厄洛替尼治疗组有所改善(HR=1.31,95%CI=1.11~1.54,Z=3.24,P=0.001),但在多西他赛与厄洛替尼治疗组中无明显差异(HR=0.90,95%CI=0.78~1.04,Z=1.40,p=0.16)。在安全性分析方面,EGFR-TKI组3~4级不良反应的发生率较低,如中性粒细胞减少症(RR=0.06,95%CI=0.04~0.08)、发热性中性粒细胞减少(RR=0.09,95%CI=0.05~0.16)、神经毒性(RR=0.25,95%CI=0.05~0.16)等,但3~4级皮疹(RR=15.03,95%CI=5.81~38.88)的发生率有所增加。结论:在非小细胞肺癌的二线治疗中,EGFR-TKI与多西他赛治疗组患者的总生存期及无进展生存期无显著差异,但EGFR-TKI可能更安全,患者耐受性更好,可以为非小细胞肺癌患者的二线治疗提供更多选择。
[Abstract]:Objective: to adopt the method of systematic evaluation, To compare the efficacy and safety of epidermal growth factor receptor tyrosine kinase inhibitor (gefitinib or erlotinib) and docetaxel in the treatment of patients with advanced non-small cell lung cancer. Databases such as Wiper, which collected data from January 1995 to March 2015, A randomized controlled trial (RTCU) associated with epidermal growth factor receptor tyrosine kinase inhibitor (EGF receptor tyrosine kinase inhibitor) for the treatment of advanced non-small cell lung cancer (NSCLC) compared with docetaxel two independent researchers sifted the literature according to the inclusion and exclusion criteria to evaluate the quality of the literature. The risk ratio (RHR), relative risk (RR) and their 95% confidence intervals were calculated. All the data were statistically analyzed using Review Manager 5.3.0.Results the meta analysis was performed on 6 eligible randomized controlled trials. A total of 2,747 patients with non-small cell lung cancer (NSCLC) who failed first-line treatment were included, of whom 1389 received EGFR-TKI therapy and 1358 received docetaxel. Meta-analysis showed that EGFR-TKI was compared with docetaxel. There was no significant difference in the total survival time between the two groups. There was no significant difference between the two groups. There was no significant difference between the docetaxel group and the erlotinib group, but there was no significant difference between the docetaxel treatment group and the erlotinib treatment group in the progression free survival time of the two groups, but there was no significant difference between the docetaxel treatment group and the erlotinib treatment group in the progressive survival time of the two groups compared with that in the erlotinib treatment group, but there was no significant difference between the docetaxel treatment group and the erlotinib treatment group. HRR 0.90 ~ 95% CIQ 0.781.40 ~ 0.160.The incidence of adverse reactions in EGFR-TKI group was lower than that in EGFR-TKI group (P < 0.05), and the incidence of adverse reactions was lower in EGFR-TKI group (P < 0.05). For example, the neutropenia is 0.06 ~ 95CII 0.04 ~ 0.08, the fever neutropenia is 0.09 ~ 95 ~ 0.16, the neurotoxicity is 0.25 ~ (95) ~ (0.05) ~ 0.16), and so on. However, the incidence of RRN 15.03C95CI5.81 / 38.88) increased. Conclusion: there is no significant difference in the overall survival and progression-free survival between the EGFR-TKI and docetaxel groups, but EGFR-TKI may be safer and the patient has better tolerance. This can provide more options for second-line therapy in patients with non-small cell lung cancer (NSCLC).
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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