不同靶向药物治疗恶性黑色素瘤皮肤并发症发生率差异的网状Meta分析

Incidence difference of cutaneous complications in different targeted drugs for treating malignant melanoma:a network Meta-analysis

目的采用网状Meta分析方法比较5种靶向药物方案治疗恶性黑色素瘤的皮肤鳞癌和皮疹发生率差异。方法计算机检索PubMed和Cochrane Library数据库,检索范围从建库起至2015年11月。网状Meta分析将直接和间接比较的证据合并,评估5种靶向药物方案治疗恶性黑色素瘤的皮肤并发症发生率差异的合并比值比(OR)和累积排序概率。结果 6项随机对照试验符合纳入标准被纳入。结果表明:与达拉非尼+曲美替尼相比,维罗非尼在患者中皮肤鳞癌发生率相对较高(OR=9.20,95%CI=1.26~52.53),维罗非尼+罗氏替尼的皮疹发生率相对较高(OR=6.81,95%CI=1.01~41.87)。累积排名曲线下面积(SUCRA)值结果表明,采用曲美替尼的患者的皮肤鳞癌发生率最低,达拉非尼+曲美替尼的皮疹发生率最低。结论达拉非尼+曲美替尼对恶性黑色素瘤患者所产生的并发症发生率最低。

Objective To adopt the network meta analysis method to compare the incidence difference of cutaneous squamous-cell carcinoma（SCC）and rash in 5kinds of targeted drugs regimen for treating malignant melanoma.Methods PubMed and Cochrane Library databases were retrieved by computer.The retrieval range was from their establishment to November 2015.The network meta analysis pooled the evidences of direct and indirect comparison for evaluating the pooled odds ratio（OR）and cumulative probability of cutaneous complications occurrence difference in 5kinds of targeted drugs regimen for treating malignant melanoma.Results Six randomized controlled trials（RCTs）conforming to the inclusion criteria were included.The meta analysis results revealed that compared with Dabrafenib＋Trametinib,the cutaneous SCC occurrence rate of Vemurafenib was higher（OR=9.20,95%CI=1.26-52.53）,while the rash occurrence rate of Vemurafenib＋Cobimetinib was higher（OR=6.81,95%CI=1.01-41.87）.The surface under the cumulative ranking curves（SUCRA）value showed that adopting Trametinib had the lowest occurrence rate for SCC,and adopting Dabrafenib＋Trametinib had the lowest occurrence rate of rash.Conclusion Dabrafenib＋Trametinibis generate the lowest complication incidence rate of malignant melanoma.