厄洛替尼联合贝伐珠单抗治疗EGFR突变晚期非小细胞肺癌患者的有效性和安全性的Meta分析  

Meta-analysis of efficacy and safety of erlotinib plus bevacizumab for advanced non-small cell lung cancer patients with EGFR-positive mutations

作　　者：胥昕怡 占美[1] 张晟肇 秦舟[1] 戴冰 徐珽[1,2] XU Xin-yi;ZHAN Mei;ZHANG Sheng-zhao;QIN Zhou;DAI Bing;XU Ting(Department of Pharmacy,West China Hospital,Sichuan University,Sichuan Chengdu 610041,China;West China School of Pharmacy,Sichuan University,Sichuan Chengdu 610041,China)

机构地区：[1]四川大学华西医院药剂科,四川成都610041 [2]四川大学华西药学院,四川成都610041

出　　处：《中国医院药学杂志》2021年第16期1658-1664,共7页Chinese Journal of Hospital Pharmacy

基　　金：四川大学华西医院技术开发项目(编号:HX-H2010209);四川省软科学研究计划项目资助(编号:2020JDR0144)。

摘　　要：目的:系统评价未经化疗的新确诊或复发的EGFR突变晚期非小细胞肺癌患者使用厄洛替尼或联合贝伐珠单抗治疗的有效性和安全性。方法:检索PubMed及其他数据库中截至2020年10月24日所有相关的随机对照临床试验。结果:最终纳入3项符合条件的随机对照临床研究,共计464例患者。Meta分析结果显示,厄洛替尼联合贝伐珠单抗化疗显著延长了未经化疗的新确诊或复发EGFR突变晚期非小细胞肺癌患者的无进展生存期(P<0.0001,HR=0.62,95%CI:0.49~0.78)。然而,联合化疗并没有明显改善该患者人群的客观缓解率(P=0.19,RR=1.08,95%CI:0.96~1.22)。联合化疗组中3级及以上级别的不良事件发生率明显高于对照组(P<0.00001,RR=1.89,95%CI:1.62~2.19)。结论:厄洛替尼联合贝伐珠单抗治疗可能会显著延长未经化疗的新确诊或复发的EGFR突变晚期非小细胞肺癌患者群体的无进展生存期,但是无法显著提高客观缓解率。同时,联合治疗方式可能会增加3级及以上不良反应的发生。这些发现可能需要更多相关临床研究进行验证。OBJECTIVE To assess the efficacy and safety of erlotinib plus bevacizumab versus erlotinib alone for newly diagnosed or relapsing advanced non-small cell lung cancer(NSCLC)patients with epidermal growth factor receptor(EGFR)mutations.METHODS All randomized controlled trials(RCTs)of PubMed and other databases up until October 24,2020 were searched.RESULTS Three eligible RCTs were included with a total of 464 patients.Meta-analysis revealed that erlotinib plus bevacizumab markedly prolonged the progression-free survival(PFS)of newly diagnosed or relapsing untreated advanced NSCLC patients with EGFR-mutated(P<0.0001,HR=0.62,95%CI:0.49-0.78).However,combination chemotherapy did not significantly improve the objective response rate(ORR)of this patient population(P=0.19,RR=1.08,95%CI:0.96-1.22).The incidence of adverse events of grade III and above was significantly higher in combined chemotherapy group than that in control group(P<0.00001,RR=1.89,95%CI:1.62-2.19).CONCLUSION Erlotinib plus bevacizumab can significantly prolong the PFS of newly diagnosed or relapsing NSCLC patients with EGFR mutations,but it fails to significantly improve ORR.At the same time,combined treatment may increase the occurrence of grade III and above adverse reactions.These findings should be verified by further clinical researches.

关 键 词：厄洛替尼 贝伐珠单抗 非小细胞肺癌 表皮生长因子受体突变 

分 类 号：R979.1[医药卫生—药品]