伊立替康联合铂类治疗复发性卵巢癌临床疗效的Meta分析

A Meta-analysis of the clinical efficacy of Irinotecan plus Platinum chemotherapy for the treatment of recurrent ovarian cancer

目的评价伊立替康联合铂类与伊立替康单药治疗复发性卵巢癌的有效性和安全性。方法计算机检索Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trials,Medline,EMBASE,National Research Register,Conference Papers Index,Open Grey,中国知网(CNKI),万方数据知识服务平台等数据库,对符合纳入标准的随机对照试验进行质量评价和Meta分析。结果纳入6个随机对照试验,共计438例患者,联合用药在完全缓解率(OR=0.53,95%CI;0.25~1.09,P=0.08)方面与单药相当,在部分缓解率(OR=0.40,95%CI:0.27~0.60,P<0.000 01)、临床有效率(OR=0.34,95%CI:0.23~0.51,P<0.000 01)上却表现出明显优于单药伊立替康的疗效,安全性方面联合用药有较高的白细胞(OR=0.25,95%CI:0.10~0.65,P=0.005)、血小板(OR=0.34,95%CI:0.16~0.71,P=0.004)骨髓抑制发生风险,但在贫血(OR=0.71,95%CI:0.37~1.33,P=0.28)、恶心呕吐(OR=0.25,95%CI:0.05~1.25,P=0.09)、腹泻(OR=0.79,95%CI:0.44~1.43,P=0.44)、神经毒性(OR=0.86,95%CI:0.44~1.06,P=0.65)及肝功能损害(OR=0.60,95%CI:0.27~1.33,P=0.21)等毒副作用发生率上与单药伊立替康比较差异无统计学意义。结论对于复发性卵巢癌患者,在排除化疗禁忌后,采取伊立替康联合铂类化疗方案能够取得较单药伊立替康更好的疗效;但对于白细胞、血小板明显降低,伴有出血倾向或不能应用升白细胞或升血小板药物的患者,可考虑使用单药伊立替康治疗。

Objective To evaluate the efficacy and safety of irinotecan plus platinum chemotherapy and irinotecan monotherapy for the treatment of recurrent ovarian cancer.MethodThe databases included Cochrane Database of Systematic Reviews,Cochrane Central Register of Controlled Trials,Medline,EMBASE,National Research Register,Conference Papers Index,Open Grey,CNKI,Wanfang data,etc.Quality assessment and meta analysis were performed for randomized controlled trials that met the inclusion criteria.ResultsSix randomized controlled trials involving438participants were included.Irinotecan plus platinum was equal to irinotecan in complete response rate(OR=0.53,95%CI;0.25to1.09,P=0.08),but better in partial response rate(OR=0.40,95%CI:0.27to0.60,P<0.00001)and overall response rate(OR=0.34,95%CI:0.23to0.51,P<0.00001).In safety,higher incidence rate of WBC(OR=0.25,95%CI:0.10to0.65,P=0.005)and PLT(OR=0.34,95%CI:0.16to0.71,P=0.004)myelosuppression and tolerable incidence rate of anemia(OR=0.71,95%CI:0.37to1.33,P=0.28),nausea and vomiting(OR=0.25,95%CI:0.05to1.25,P=0.09),diarrhea(OR=0.79,95%CI:0.44to1.43,P=0.44),neurotoxicity(OR=0.86,95%CI:0.44to1.06,P=0.65)and hepatic dysfunction(OR=0.60,95%CI:0.27to1.33,P=0.21)were confirmed for irinotecan plus platinum therapy compared with irinotecan monotherapy.ConclusionsFor recurrent ovarian cancer patients,after eliminating chemotherapy taboo,using irinotecan plus platinum could bring better efficacy.But for those whose white blood cells(WBC)or platelets(PLT)reduce significantly,associated with bleeding tendency,or inability to use drugs which can improve WBC and PLT levels,irinotecan monotherapy would be considered.