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转移性结直肠癌的二线系统治疗:基于RCT的系统审查和贝叶斯网络元分析

Chengyu Sun¹, Enguo Fan², Luqiao Huang¹

¹Department of Colorectal Surgery, The Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.

|December 23, 2024

概括

对于转移性结直肠癌 (mCRC),FOLFOX加Bevacizumab是顶级的二线治疗. 对于RAS突变mCRC的患者,建议使用FOLFIRI加Bevacizumab和Panitumumab,以获得更好的生存结果.

科学领域:

在瘤学瘤学.
临床药理学临床药理学
生物统计学生物统计学

背景情况:

转移性结直肠癌 (mCRC) 的最佳二线全身治疗方法尚不清楚.
综合证据对于指导先进癌症治疗的临床决策至关重要.

研究的目的:

系统地比较mCRC的各种二线全身治疗的疗效和安全性.
根据患者子组确定最佳治疗策略,包括RAS基因状态.

主要方法:

在主要数据库 (PubMed,科学网,EMBASE,科克兰图书馆) 进行了全面的文献搜索,截至2024年2月.
使用马尔科夫链蒙特卡洛 (MCMC) 技术的网络元分析 (NMA) 用于分析无进展生存率 (PFS),整体反应率 (ORR),整体生存率 (OS) 和不良事件 (AE).
累计排名曲线下的表面 (SUCRA) 用于对治疗进行排名,并对RAS基因状态进行亚组分析.

主要成果:

分析了47项随机对照试验 (RCT),涉及16,925名患者和44种治疗方法.
福福克斯 + 贝瓦西祖马布 + 埃尔洛丁尼布在改善整体存活率方面表现出优越性 (OS SUCRA: 92.7%).
氨酸 + CMAB009在无进展生存中表现出优势 (PFS SUCRA: 86.4%),而FOLFIRI + Trebananib在整体应答率方面表现出色 (ORR SUCRA: 88.1%).
在PFS,OS,ORR和部分响应 (PR) 中,FOLFOX + Bevacizumab显示出有利的结果,安全性可比.
在RAS突变种群中,FOLFIRI + Bevacizumab + Panitumumab在OS (87.9%) 和PFS (70.2%) 中表现优越.
在RAS野生型人群中,FOLFIRI + Bevacizumab显著改善了OS (73.2%) 和PFS (65.1%).

结论:

对于大多数mCRC患者来说,FOLFOX + Bevacizumab被建议作为潜在的最佳二线全身治疗.
建议使用FOLFIRI + Bevacizumab + Panitumumab治疗RAS突变的mCRC种群.
治疗决策应考虑个体患者的生理状态和临床背景.

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