阿昔替尼治疗晚期或转移性肾细胞癌的快速卫生技术评估

Rapid health technology assessment of axitinib in advanced renal cell carcinoma

目的基于快速卫生技术评估(HTA)方法,评价阿昔替尼治疗晚期肾细胞癌(aRCC)或转移性肾细胞癌(mRCC)的有效性、安全性和经济性。方法系统检索PubMed、the Cochrane Library、中国知网和万方等数据库。由2位评价者根据入选与排除标准独立筛选文献、提取资料和评价质量后,对有效性、安全性和经济性进行综合分析。结果共纳入2篇HTA报告、6篇Meta分析和6篇经济学研究,被评价药物包括阿昔替尼、索拉非尼、舒尼替尼、培唑帕尼和依维莫司。阿昔替尼用于aRCC或mRCC一线或二线治疗的有效性结果不一致。与依维莫司、舒尼替尼相比,阿昔替尼的无进展生存期差异均无统计学意义。与索拉非尼、培唑帕尼相比,在不区分一线和二线治疗的情况下,阿昔替尼有明显优势(阿昔替尼vs索拉非尼,HR=0.694,95%Cl=0.586~0.821;阿昔替尼vs培唑帕尼,OR=0.64,95%Cl=0.42~0.98),但对于mRCC一线治疗,阿昔替尼无明显优势(阿昔替尼vs索拉非尼,OR=1.5,95%Cl=0.8~2.5;阿昔替尼vs培唑帕尼,OR=1.1,95%Cl=0.5~2.4)。安全性方面,与舒尼替尼、索拉非尼相比,阿昔替尼有明显优势,与培唑帕尼和依维莫司相比差异均无统计学意义。经济性方面,目前证据不足,仅从现有证据考虑,阿昔替尼优于索拉非尼、培唑帕尼,但不及依维莫司、舒尼替尼。结论aRCC目前循证证据不一致,结合药物的有效性、安全性和经济性,一线治疗阿昔替尼优于索拉非尼、舒尼替尼和培唑帕尼。二线治疗依维莫司优于阿昔替尼,阿昔替尼优于索拉非尼、舒尼替尼和培唑帕尼。

Objective To evaluate the effectiveness,safety and economy of axitinib in advanced renal cell carcinoma(aRCC)patients using rapid health technology assessment(HTA).Methods PubMed,the Cochrane Library,CNKI,Wanfang databases were systematically searched.Two reviewers independently identified studies,extracted data and assessed the quality of included studies.Qualitative analysis was performed with efficacy,safety and economy.Results Two HTA reports,6 systematic reviews and 6 pharmacoeconomic studies were included.The evaluated drugs include axitinib,sorafenib,sunitinib,prazopari and everolimus.The efficacy of axitinib in aRCC or mRCC was inconsistent.Compared with everolimus or sunitinib,there was no significant difference in progression free survival between axitinib and everolimus,or axitinib and sunitinib.Compared with sorafenib and panzopanib,axitinib had longer progression-free survival(axitinib vs sorafenib,HR=0.694,95%Cl=0.586-0.821;axitinib vs panzopanib,OR=0.64,95%Cl=0.42-0.98)without distinguishing the first-line treatment from the second-line treatment,but there was no significant difference for the first-line treatment of mRCC(axitinib vs sorafenib,OR=1.5,95%Cl=0.8-2.5;axitinib vs panzopanib,OR=1.1,95%Cl=0.5-2.4).In terms of safety,axitinib was superior to sunitinib and sorafenib,but compared with panzopanib and everolimus,axitinib had no obvious advantages.There was insufficient economic evidence at present.The economic analysis showed that axitinib was superior to sorafenib and panzopanib,but inferior to everolimus and sunitinib.Conclusion The evidence for aRCC is inconsistent.In general,axitinib is superior to sorafenib,sunitinib and panzopanib in the first-line treatment of aRCC.In the second-line treatment,everolimus is superior to axitinib,and axitinib is superior to sorafenib,panzopanib and sunitinib.