吉非替尼、厄洛替尼和埃克替尼治疗非小细胞肺癌临床疗效及不良反应的网络Meta分析

发布时间：2018-07-25 14:50

【摘要】：目的:目前,吉非替尼、厄洛替尼及埃克替尼治疗非小细胞肺癌的临床疗效尚存在一定争议,本研究通过网络meta分析比较三种药物治疗非小细胞肺癌的临床疗效及安全性,为非小细胞肺癌的临床药物应用提供一定的参考依据。方法:两名研究者对Cochrane、PubMed、EMbase、Sciencedirect、CNKI、万方和维普等数据库独立地检索文献,并进行文献筛选、提取资料和交叉核对。结局指标包括完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)、疾病进展(PD)、总有效率(ORR)、疾病控制率(DCR)、无进展生存期(PFS)、中位生存时间(MST)、不良反应等。其中不良反应包括皮疹、腹泻、恶心呕吐、肝功异常及乏力。纳入研究的结果采用Rev Man 5.2软件、R3.3.0软件及Stata 13.0软件进行结果分析。结果:共纳入43篇文献,7168例患者。网络meta分析发现,CR、PR、SD、PD、ORR及DCR未见统计学差异;对于不良反应,厄洛替尼发生恶心呕吐为吉非替尼的2.0倍(95%Cr I:1.1-3.7),而皮疹、腹泻、肝功异常及乏力未见统计学差异。药物之间两两比较的meta分析发现,吉非替尼的SD为厄洛替尼的0.86倍(95%CI:0.75-0.99,P=0.04);吉非替尼引起皮疹的风险为厄洛替尼的0.45倍(95%CI:0.36 0.55,P0.05),是埃克替尼的1.57倍(95%CI:1.18 2.09,P=0.002);吉非替尼引起腹泻的风险为厄洛替尼的0.75倍(95%CI:0.61 0.92,P=0.005);吉非替尼引起的恶心呕吐为厄洛替尼的0.47倍(95%CI:0.27-0.84,P=0.01);吉非替尼引起乏力的风险为厄洛替尼的0.43倍(95%CI:0.24-0.76,P=0.004)。吉非替尼、厄洛替尼和埃克替尼的PFS分别为5.48个月、5.15个月、5.81个月,吉非替尼和埃克替尼均高于厄洛替尼(P0.05);其MST分别为13.26个月、13.52个月、12.58个月,厄洛替尼分别高于吉非替尼及埃克替尼(P0.05)。结论:吉非替尼、厄洛替尼及埃克替尼治疗非小细胞肺癌患者的临床疗效差异不明显,但吉非替尼引起恶心呕吐及乏力的发生率较低;厄洛替尼治疗可以取得较长的中位生存时间,但皮疹、腹泻及恶心呕吐的发生率相对较高;埃克替尼发生皮疹和腹泻较低,临床上可根据患者的具体情况选择药物治疗。
[Abstract]:Objective: at present, the clinical efficacy of gefitinib, erlotinib and ectini in the treatment of non-small cell lung cancer (NSCLC) is still controversial. This study compared the clinical efficacy and safety of three drugs in the treatment of NSCLC by network meta analysis. To provide a certain reference for the clinical application of non-small cell lung cancer. Methods: two researchers searched independently the databases such as Cochranein PubMeden EMbase Science Direction CNKI, Wanfang and Weip, and carried out literature screening, extracting data and cross-checking. Outcome indicators included complete remission of (CR), partial remission of (PR), stable progression of (SD), disease progression (PD), total effective (ORR), disease control rate (DCR), progression free survival (PFS), median survival time (MST), adverse reactions and so on. Adverse reactions include rash, diarrhea, nausea and vomiting, liver dysfunction and fatigue. The results were analyzed by Rev Man 5.2 software R3.3.0 and Stata 13.0 software. Results: a total of 7168 patients were included in 43 articles. Network meta analysis showed that there was no significant difference in DCR and DCR, but there was no statistical difference in the incidence of nausea and vomiting of erlotinib (95%Cr I: 1.1-3.7), but in rash, diarrhea, abnormal liver function and asthenia. Meta analysis of pairwise comparisons between drugs found that, The SD of gefitinib was 0.86 times that of erlotinib (95CI: 0.75-0.99P0.04), the risk of rashes caused by gefitinib was 0.45 times that of erlotinib (95%CI:0.36 0.55P 0.05), and that of 95%CI:1.18 2.09P0.002; the risk of diarrhea caused by gefitinib was 0.75 times that of erlotinib (95%CI:0.61 0.92P 0.005); and that of gefitinib was 0.75 times that of erlotinib (95%CI:0.61 0.92P0.005). The risk of nausea and vomiting was 0.47 times higher than that of erlotinib (95 CI: 0.27-0.84P0. 01), and the risk of fatigue caused by gifetini was 0.43 times that of erlotinib (95 CI: 0.24-0.76P0. 004). The PFS of gefitinib, erlotinib and ectini were 5.48 months, 5.15 months and 5.81 months, respectively. The MST of gefitinib and Ectini were higher than that of erlotinib (P0.05), their MST were 13.26 months, 13.52 months, 12.58 months, respectively. Erlotinib was higher than gefitinib and Ectini (P0.05). Conclusion: there is no significant difference in the clinical efficacy of gefitinib, erlotinib and ectini in the treatment of non-small cell lung cancer, but the incidence of nausea, vomiting and fatigue caused by gefitinib is lower. The median survival time of erlotinib treatment was longer, but the incidence of rash, diarrhea, nausea and vomiting was relatively high, and the incidence of ectinib rash and diarrhea was lower, and the drug therapy could be selected according to the specific conditions of the patients.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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