吉西他滨联合分子靶向药物及铂类药物治疗中晚期胰腺癌患者安全性和有效性的META分析

发布时间：2018-03-26 04:43

本文选题：吉西他滨　切入点：分子靶向药物　出处：《河北医科大学》2016年硕士论文

【摘要】：目的:通过Meta分析,讨论吉西他滨(Gemcitabine,GEM)联合分子靶向药物(Molecular targeted drugs,MTD)或铂类药物(Platinum drugs,PD)对比吉西他滨单药或联合安慰剂化疗在中晚期胰腺癌治疗中的安全性和有效性。方法:通过检索EMBASE、PubMed、Cochrane Library数据库、中国知网数据库、中国万方数据库、中国生物医学数据库,查找截止到2015年7月31日在中国境内和境外已发表的治疗中晚期胰腺癌的相关文献。选择联合用药组为吉西他滨联合分子靶向药物(如厄洛替尼、马赛替尼、阿西替尼、索拉非尼、贝伐单抗、西妥昔单抗和替吡法尼等)或联合顺铂或奥沙利铂化疗,单药组为吉西他滨或加用安慰剂;选择的研究必须符合临床随机对照的标准。检索与收集资料应由两位评价者分别独立进行,严格按照纳入标准筛选文献,总生存期、无进展生存期为主要分析指标,客观缓解率、疾病控制率和不良反应(包括胃肠道反应和血液学反应)为次要分析指标。结果:1关于吉西他滨联合分子靶向药物的随机对照试验,共纳入11项。经过Meta分析,可知吉西他滨联合分子靶向药物化疗可明显提高患者的疾病控制率(OR=1.23,95%CI=[1.07,1.41],P=0.0040.01),但同时在化疗毒性反应中,中性粒细胞减少(OR=1.20,95%CI=[1.04,1.40],P=0.01)、及恶心症状发生率增加(OR=1.26,95%CI=[1.07,1.48],P=0.005)。2关于吉西他滨联合铂类药物的随机对照试验,共纳入11项。经过Meta分析,可知吉西他滨联合铂类药物化疗可明显提高患者的疾病控制率(OR=1.63,P=0.00050.01)、及客观缓解率(OR=1.48,P=0.0060.01),但与此同时也增加患者药物不良反应发生率,致使血小板减少(P=0.02)及胃肠道反应(P=0.0002)的发生率明显提高。结论:1吉西他滨联合分子靶向药物用于中晚期胰腺癌患者能有效提高患者的疾病控制率,虽中性粒细胞及恶心症状也明显增加,但总体能使疾病疗效有所提高,临床值得进一步研究应用。2吉西他滨联合铂类药物治疗中晚期胰腺癌患者,可提高患者的客观缓解率,改善疾病控制,但会引起药物不良反应增加,致使患者血小板减少发生率升高,增加胃肠道反应的发生。
[Abstract]:Objective: by Meta analysis, To discuss the safety and efficacy of gemcitabine Gemcitine gel (Gem) combined with molecular targeted drugs (MTD) or platinum drug Platinum drugsl (PDD) in the treatment of advanced pancreatic cancer. Methods: EMBASE PubMedCochrane Library database was searched by comparing the efficacy and safety of gemcitabine alone or placebo chemotherapy in the treatment of advanced pancreatic cancer. China knowledge Network Database, China Wanfang Database, China Biomedical Database, To find the literature on the treatment of advanced pancreatic cancer published in China and abroad as of July 31, 2015. The combination group was selected as gemcitabine combination molecular targeted drugs (e. G. Erlotinib, Masetinib, Asetini, etc.). Solafenib, bevacizumab, cetuximab and tipifanil) or combination chemotherapy with cisplatin or oxaliplatin, single group with gemcitabine or plus placebo; The selected study must meet the criteria of clinical randomized control. The retrieval and collection of data should be conducted independently by the two evaluators, and the literature should be screened strictly according to the inclusion criteria. The total survival period and progression-free survival were the main analysis indicators. Objective remission rate, disease control rate and adverse reactions (including gastrointestinal reaction and hematological response) were secondary analysis indicators. Results: the randomized controlled trial of gemcitabine combined molecular targeted drugs by 1: 1 included 11 items. Meta analysis was performed. The results showed that gemcitabine combined with molecular targeted drug chemotherapy could significantly improve the disease control rate of patients. Neutrophil neutropenia 1.20995 CI = [1.041.40] Pu 0.01g, and the incidence of nausea increased 1.26995 CI = [1.071.48] Pl 0.0050.2. A randomized controlled trial of gemcitabine combined with platinum drugs was conducted. 11 items were included in the randomized controlled trial of gemcitabine combined with platinum. The results showed that gemcitabine combined with platinum chemotherapy could significantly improve the disease control rate and objective remission rate, but also increased the incidence of adverse drug reactions. The incidence of thrombocytopenia (P0. 02) and gastrointestinal reaction (P0. 0002)) was significantly increased. Conclusion: 1 gemcitabine combined with molecular targeted drugs can effectively improve the disease control rate of patients with advanced pancreatic cancer. Although the neutrophil and nausea symptoms also increased significantly, the overall curative effect of the disease was improved. It is worthy of further study on the clinical application of .2 gemcitabine combined with platinum drugs in the treatment of advanced pancreatic cancer patients, which can improve the objective remission rate of the patients. Improve disease control, but will cause an increase in adverse drug reactions, lead to increased incidence of thrombocytopenia, increase gastrointestinal reaction.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.9

【相似文献】