酪氨酸激酶抑制剂治疗Her-2阳性乳腺癌脑转移疗效的单臂meta分析  

Efficacy of tyrosine kinase inhibitors in the treatment of brain metastases from Her-2 positive breast cancer:a single-arm meta-analysis

作　　者：邵丽华 宋海侠[1] 祁月潇 董玉梅[1] 郭丽云[1] 蔡雅琴 魏世鸿[1] SHAO Lihua;SONG Haixia;QI Yuexiao;DONG Yumei;GUO Liyun;CAI Yaqin;WEI Shihong(Department of Radiotherapy,Gansu Provincial Cancer Hospital,Gansu,Lanzhou 730050,China)

机构地区：[1]甘肃省肿瘤医院放疗科,甘肃兰州730050

出　　处：《中国医药科学》2024年第11期124-129,共6页China Medicine And Pharmacy

基　　金：甘肃省卫生健康行业科研计划项目(GSWSKY2021-057);甘肃省兰州市科技计划项目(2023-4-54);甘肃省兰州市科技发展指导性计划项目(2019-ZD-134)。

摘　　要：目的探讨酪氨酸激酶抑制剂(TKIs)在Her-2阳性乳腺癌脑转移(BCBM)中的疗效。方法检索从建库至2022年4月11日数据库(PubMed、Cochranelibrary、Embase)中TKIs治疗Her-2阳性BCBM的临床研究,采用STATA 17.0进行meta分析。结果纳入15项研究,其中3项关于TKIs单药治疗,12项关于联合治疗,meta分析显示TKIs单药治疗的疗效欠佳,与未使用TKIs治疗相比总生存期(OS)差异不显著(P>0.05),但TKIs联合治疗的疗效改善,与未使用TKIs治疗、未使用抗Her-2治疗或仅基于曲妥珠单抗治疗相比,OS差异有统计学意义(P<0.05);中枢神经系统(CNS)进展为TKIs单药或联合药物治疗的主要进展方式,发生率为59.0%~82.2%,而TKIs联合放疗的CNS复发率降低为22.9%。结论基于TKIs的联合治疗能够改善Her-2阳性BCBM的预后,但CNS复发率仍然很高,TKIs联合放疗能够降低CNS复发率,但相关的前瞻性临床研究较少,需更多前瞻性临床研究进一步确定最佳治疗策略。Objective To investigate the efficacy of tyrosine kinase inhibitors(TKIs)in Her-2 positive breast cancer brain metastasis(BCBM).Methods The clinical studies of TKIs in the treatment of Her-2 positive BCBM from the establishment of the database to April 11th,2022(PubMed,Cochrane Library,Embase)were searched,and the metaanalysis was conducted with STATA17.0.Results A total of 50 studies were included,of which 3 were about TKIs monotherapy and 12 were about combination therapy.Meta-analysis showed that the efficacy of TKIs monotherapy was poor,and there was no significant difference in overall survival(OS)between it and the treatment without TKIs(P>0.05).However,the efficacy of TKIs combination therapy was improved:the OS of TKIs combination therapy was better than that of the treatment without TKIs,treatment without anti-Her-2 drugs or trastuzumab monotherapy.The progression of central nervous system(CNS)was the main progression mode of TKIs monotherapy or combined drug therapy,with an incidence of about 59.0%-82.2%,while the CNS recurrence rate of TKIs combined with radiotherapy was reduced to 22.9%.Conclusion TKIs-based combination therapy can improve the prognosis of Her-2 positive BCBM,but the CNS recurrence rate is still high.TKIs combined with radiotherapy can reduce the CNS recurrence rate,but there are few related prospective clinical studies,and more prospective clinical studies are needed to further determine the best treatment strategy.

关 键 词：Her-2阳性乳腺癌 脑转移 酪氨酸激酶抑制剂 META分析 

分 类 号：R737.9[医药卫生—肿瘤]