沙利度胺联合第三代含铂化疗方案治疗晚期非小细胞肺癌的Meta分析

Thalidomide plus third generation platinum-contained chemotherapy regimens in treatment of non-small cell lung cancer:A Meta analysis

目的系统评价沙利度胺联合第三代含铂化疗方案治疗晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)的临床疗效和安全性。方法计算机检索Cochrane Library、Pubmed、EMBASE、CancerLit、中国生物医学文献数据库等相关数据库,纳入沙利度胺联合第三代含铂化疗方案治疗NSCLC的随机对照试验(Randomized Controlled Trials,RCTs)。结果共纳入9篇RCTs,共1 256位患者,Meta分析结果显示:单纯第三代含铂化疗方案与沙利度胺联合第三代含铂化疗方案在有效率、临床受益率、骨髓抑制、消化道反应、肝肾毒性、神经系统毒性方面的差异无统计学意义。沙利度胺联合第三代含铂化疗方案较单用第三代含铂化疗方案,可明显降低血清VEGF含量(RR=-91.43,95%CI:125.82,57.03,P<0.000 01),但前者可显著增加血栓事件(RR 1.74 95%CI:1.20-2.52;P=0.003)和皮疹(RR=4.23,95%CI:1.45-12.39,P=0.008)发生率。结论沙利度胺联合第三代含铂化疗方案不能提高NSCLC治疗的近期疗效,较单用第三代含铂化疗方案,可明显降低血清VEGF含量,可显著增加血栓事件和皮疹的发生率。不推荐沙利度胺联合第三代含铂化疗方案治疗晚期非小细胞肺癌。

Objective To evaluate the efficacy and safety of thalidomide plus the third generation platinum-contained chemotherapy regimen for patients with advanced non-small cell lung cancer（NSCLC）.Methods Relevant randomized controlled trials（RCT） were searched from Cochrane library,PubMed,EMBase,CancerLit,VIP,CBM,etc.RCT of thalidomide plus the third generation platinum-contained chemotherapy regimen vs the third generation platinum-contained chemotherapy regimen for advanced NSCLC were included.Quality of these included studies was analyzed using the Cochrane Collaboration’s RevMan 5.0 software.Results Nine RCTs involving 1 256 patients were included.Meta analysis showed no significant difference in effective rate,clinical benefit rate,bone marrow inhibition,digestive tract reaction,renal and neural system toxicity between the two treatment modalities.The serum VEGF level（RR=-91.43,95%CI=125.82 and 57.03,P〈0.000 01） was significantly lower and the incidence of thrombotic events（RR=1.74,95% CI=1.20-2.52,P=0.003） and rashes（RR=4.23,95%CI： 1.45-12.39,P=0.008） was significantly higher after treatment with thalidomide plus the third generation platinum-contained chemotherapy regimen than with the third generation platinum-contained chemotherapy regimen alone.Conclusion Thalidomide plus the third generation platinum-contained chemotherapy regimen cannot improve the short-term therapeutic effect on NSCLC,but it can decrease the serum VEGF level and increase the incidence of thrombotic events and rashes more significantly than the third generation platinum-contained chemotherapy regimen alone,it is thus not recommended for advanced NSCLC.