对于患有晚期非小细胞肺癌,性能状态为2且没有可向突变或突变状态不明的人来说,最佳的第一线治疗
Rolof Gp Gijtenbeek1, Kim de Jong2, Ben Jw Venmans1
1Department of Pulmonary Diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands.
The Cochrane database of systematic reviews
|July 7, 2023
概括
双重疗法改善了高级非小细胞肺癌 (NSCLC) 患者的存活率. 虽然它增加了毒性,但与非选项相比,它提供了更好的整体生存和无进展生存.
科学领域:
- 在瘤学瘤学.
- 临床试验 临床试验
- 基于证据的医学基于证据的医学.
背景情况:
- 先进的非小细胞肺癌 (NSCLC) 诊断往往呈现出表现不佳的状态 (PS),使治疗决策复杂化.
- 缺乏可向突变的PS2患者,代表了一个显著的亚组 (20-30%),不清楚最佳的第一线治疗.
- 从历史上看,PS 2患者经常被排除在临床试验之外,从而造成了对其治疗疗效和安全的知识差距.
研究的目的:
- 确定最有效的第一线治疗先进NSCLC在PS2和没有可向突变或未知突变状态的患者.
- 系统地审查和综合来自随机对照试验 (RCT) 的证据,比较这个特定患者群体的不同治疗方案.
主要方法:
- 在2022年6月17日之前进行了全面的Cochrane搜索.
- 包括RCT比较PS2患者或相关子组的化疗 (含或不含血管生成抑制剂) 或免疫治疗方案.
- 评估的主要结局是整体存活率 (OS),与健康相关的生活质量 (HRQoL) 和毒性;二级结局包括瘤反应率和无进展存活率 (PFS).
主要成果:
- 与非白金疗法相比,白金双重化疗显示出更高的整体存活率 (OS) (HR 0.67,中等确定性证据).
- 无进展生存率 (PFS) 和瘤应答率也在双重疗法 (中等确定性证据) 中显著改善.
- 双疗法与3-5级血液毒性增加有关 (低确定性证据),但HRQoL数据在研究中有限且不确定的.
结论:
- 双疗法被推作为非治疗的首选一线治疗,用于PS2的晚期NSCLC患者,提供更好的生存率和反应率.
- 尽管血液中毒性增加,但双治疗的好处超过了这种人群的风险.
- 对于免疫疗法,特别是检查点抑制剂在PS2高级NSCLC患者的疗效,有必要进行更多的研究.
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