摘要
目的 对免疫治疗与贝伐珠单抗联合化疗、贝伐珠单抗联合化疗、免疫治疗联合化疗、贝伐珠单抗联合免疫治疗、贝伐珠单抗和化疗一线治疗晚期驱动基因野生型非鳞状非小细胞肺癌的疗效及安全性进行网状Meta分析。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science数据库,搜集与研究目的相关的Ⅱ/Ⅲ期随机对照试验(RCT),检索时限均为2010年1月至2022年12月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R 3.6.1软件进行网状Meta分析。结果 最终纳入11个RCT,包括5 329例患者和6种治疗组合。Meta分析结果显示,对于无进展生存期(PFS),BIC优于CT[HR=0.34,95%CI(0.18,0.69)],但对于总体生存期(OS),BIC较其余组未显示出明显优势。最佳概率排序结果显示BIC组在OS、PFS、ORR方面最优的概率最大。在所有程序性死亡配体中1(PD-L1)表达亚组中,BIC、BC、IC、CT、BI和B组间的OS无显著差异。IC相较于CT,OS[HR=0.68,95%CI(0.52,0.92)]、PFS[HR=0.58,95%CI(0.45,0.75)]和客观缓解率[HR=0.47,95%CI(0.33,0.66)]都可以得到明显改善。结论 在驱动基因阴性晚期非鳞状NSCLC一线治疗中,免疫治疗、贝伐珠单抗疗联合化疗可能会短期改善疗效,但并不改变长期生存时间。免疫治疗联合化疗相较于单纯化疗,可明显改善患者生存期及预后。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
Objective To analyze the efficacy and safety of immunotherapy and bevacizumab combined with chemotherapy(BIC),bevacizumab combined with chemotherapy(BC),chemotherapy(CT),immunotherapy combined with chemotherapy(IC),bevacizumab combined with immunotherapy(BI),bevacizumab(B)in the first-line treatment of advanced wild-type non-squamous non-small cell lung cancer.Methods The PubMed,Embase,Cochrane Library and Web of Science databases were searched to collect phaseⅡ/Ⅲrandomized controlled trials(RCTs)related to the objectives of the study from January 2010 to December 1,2022.After two investigators independently screened the literatures,extracted the data and evaluated the risk of bias of the included studies,a reticular meta-analysis was performed using R 3.6.1 software.Results A total of 11 RCTs were finally included,including 5329 patients and six treatment combinations.Meta-analysis results showed that BIC was superior to CT for progression-free survival(PFS)(HR=0.34,95%CI 0.18 to 0.69),but BIC did not show a significant advantage over the other groups for overall survival(OS).Bayesian ranking results showed that the BIC group had the greatest probability in terms of OS,PFS,and ORR.Among all programmed death ligand 1(PD-L1)expressing subgroups,there was no significant difference in OS between BIC,BC,IC,CT,BI,and B.Compared with CT,IC was significantly improved in OS(HR=0.68,95%CI 0.52 to 0.92),PFS(HR=0.58,95%CI 0.45 to 0.75),and ORR(HR=0.47,95%CI 0.33 to 0.66).Conclusion In the first-line treatment of wildtype advanced non-squamous NSCLC,immunotherapy and bevacizumab combined with chemotherapy may improve the efficacy in the short term,but do not change the long-term survival time.Immunotherapy combined with chemotherapy can significantly improve the survival time and prognosis of patients compared with chemotherapy alone.Due to the limited quantity and quality of the included studies,more high-quality studies are needed to verify the above conclusion.
作者
宋杨
朱宇熹
SONG Yang;ZHU Yuxi(Department of Oncology,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2023年第11期1275-1283,共9页
Chinese Journal of Evidence-based Medicine
关键词
免疫治疗
贝伐珠单抗
一线治疗
驱动基因阴性
晚期非鳞非小细胞肺癌
Immune checkpoint inhibitor
Bevacizumab
Chemotherapy
First-line treatment
Wild-type nonsquamous non-small cell lung cancer
作者简介
通信作者:朱宇熹,Email:zhuyuxi@hospital.cqmu.edu.cn。
