"从低开始,慢慢进行",一种针对老年人或患有晚期固体癌症的易受伤害的成年人量身定制治疗剂量的策略:系统性审查和元分析
Gabriel Aleixo1, Tej Patel2, Julianne Ani3
1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Journal of geriatric oncology
|November 13, 2024
概括
在有固体瘤的老年人中,开始低,慢慢 (SLGS) 治疗癌症的策略可能会减少毒性,而不会影响整体存活率. 这种方法以较低的剂量开始治疗,随着耐受性升级,为脆弱的患者提供潜在的更安全的选择.
科学领域:
- 老年瘤学 老年瘤学
- 癌症治疗方法 癌症治疗方法
- 临床药理学 临床药理学
背景情况:
- 标准剂量的癌症治疗可以损害老年人的功能能力.
- 开始低,缓慢 (SLGS) 战略提供了一种定制的方法,以减轻易受癌症患者的毒性.
- 患有无法治愈的固体瘤的老年人代表了可能受益于剂量修改化疗的人群.
研究的目的:
- 系统地审查和元分析SLGS策略在患有无法治愈的固体瘤的老年人中的有效性.
- 评估与SLGS方法相关的整体存活率 (OS),治疗中止和毒性.
- 在实体瘤学中收集利用SLGS策略的研究数据.
主要方法:
- 对前性研究的系统审查和随机效应元分析,涉及接受SLGS的固体瘤患者.
- 在PubMed/Medline,老年瘤学杂志,ASCO摘要和EMBASE进行的搜索.
- 使用纽卡斯尔-太华质量 (NOQ) 尺度评估的方法质量和用GRADE分级的证据.
主要成果:
- 三项研究的元分析表明,SLGS与较低的死亡率相关 (HR 0.91,95% CI 0.85-0.98,p=0.01).
- 与标准剂量相比,SLGS显示了降低的3级和4级毒性 (RR 0.86,95% CI 0.75-0.98,p<0.02).
- 在SLGS和标准剂量之间没有观察到治疗中止率的显著差异 (RR 0.96,95% CI 0.87-1.05,p=0.37).
结论:
- 在老年患者中,SLGS方法可以降低固体瘤的毒性,而不会影响存活率.
- 结果受限于少数专门关注老年人的前性研究.
- 需要进一步的研究,以阐明SLGS在老年人的息化疗中的全部影响.
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