摘要
目的:系统评价曲妥珠单抗辅助化疗治疗HER2阳性乳腺癌的有效性和安全性。方法:计算机检索国内外1996-2013年发表的曲妥珠单抗辅助化疗治疗HER2阳性乳腺癌的前瞻性随机对照临床试验(Rcts)研究,对符合纳入标准的研究以Jadad评分标准进行文献质量评价,并使用Review Manager 5.3软件进行Meta分析。结果:共纳入4项Ⅲ期Rcts(其中有两项Rcts为合并分析)。Meta分析结果显示,与单纯化疗相比,曲妥珠单抗联合化疗治疗HER2阳性乳腺癌可以显著延长患者的无病生存期DFS[HR=0.63,95%CI(0.50,0.81),P〈0.001]和总生存期OS[HR=0.69,95%CI(0.56,0.86),P=0.001]。在安全性方面,曲妥珠单抗联合化疗组心脏事件[RR=5.09,95%CI(3.23,8.03),P〈0.00001]及充血性心力衰竭[RR=5.32,95%CI(2.28,12.44),P=0.0001]发生率显著高于单纯化疗组,而在心脏事件导致的死亡方面,两组无显著差异。结论:曲妥珠单抗联合化疗治疗HER2阳性乳腺癌的疗效显著优于单纯化疗,但心脏事件也显著增加。
Objective: To systematically evaluate the efficacy and safety of trastuzumab in adjuvant therapy for HER2-positive breast cancer. Methods: Computerized search was performed to identify prospective random control trials published both in the domestic and overseas during 1996 to 2013 comparing adjuvant chemotherapy with or without trastuzumab in HER2-positive breast cancer patients. Jadad grading standard was used to appraise the quality of the included studies. Review Manager 5. 3 was used to conduct the Metaanalysis. Results: With 4 eligible Phase III clinical randomized controlled trials( Rcts) identified( 2 of them were joint analysis),this analysis demonstrated that patients with HER2-positive breast cancer derived benefit in disease-free survival [HR = 0. 63,95% CI( 0. 50,0. 81),P〈0. 001],overall survival [HR = 0. 69,95% CI( 0. 56,0. 86),P = 0. 001]from the addition of trastuzumab to adjuvant chemotherapy,whereas trastuzumab bore a higher incidence of cardiac event[RR = 5. 09,95% CI( 3. 23,8. 03),P〈0. 00001] and congestive cardiac failure [RR = 5. 32,95% CI( 2. 28,12. 44),P = 0. 0001]as compared to the control group. However,the addition of trastuzumab made no significant difference in cardiac death. Conclusion: The curative effect of adjuvant trastuzumab is significantly better than chemotherapy alone in patients with HER2-positive breast cancer with cardiac toxicity increased.
出处
《中国药物评价》
2015年第1期35-40,共6页
Chinese Journal of Drug Evaluation