埃克替尼治疗非小细胞肺癌的快速卫生技术评估

Icotinib for the Treatment of Non-small Cell Lung Cancer:A Rapid Healthy Technology Assessment

目的:对埃克替尼治疗非小细胞性肺癌(NSCLC)的安全性、有效性和经济性进行初步评估,以满足决策者的需要。方法:系统检索各国卫生技术评估(HTA)数据库,以及PubMed、Cochrane、CNKI和WanFang Data等中英文文献数据库,搜集埃克替尼治疗NSCLC的系统评价/Meta分析、经济学研究以及HTA报告,由2名评价者根据纳入排除标准提取数据,对结果进行定性分析。结果:共纳入系统评价/Meta分析9篇,经济学研究8篇。埃克替尼与厄洛替尼、吉非替尼、培美曲塞为基础的化疗和培美曲塞自由化疗相比可显著延长患者无进展生存期(PFS)。但埃克替尼相比奥西替尼、达可替尼、厄洛替尼联用贝伐单抗和吉非替尼联用培美曲塞为基础的化疗,其PFS均不占优势。埃克替尼与厄洛替尼,埃克替尼联合紫杉醇+顺铂(TP)与单纯TP治疗,埃克替尼与常规或其他药物治疗相比可显著提高患者客观缓解率(ORR)。埃克替尼与奥西替尼和吉非替尼联用培美曲塞为基础的化疗相比,其OS较短。而埃克替尼与厄洛替尼、吉非替尼、达可替尼和阿法替尼等其他表皮生长因子酪氨酸激酶抑制药(EGFR-TKIs)相比,总生存期(OS)无显著差异。安全性方面,埃克替尼与厄洛替尼,吉非替尼,常规或其他药物治疗相比可显著降低患者总不良反应发生率(ADR)。埃克替尼与厄洛替尼联用贝伐单抗、培美曲塞为基础的化疗和培美曲塞自由化疗相比可显著降低患者的3级以上不良事件的发生。纳入的经济学研究表明,埃克替尼与吉非替尼、厄洛替尼、培美曲塞或单纯放化疗相比有成本-效果优势。结论:埃克替尼治疗NSCLC具有良好的有效性,安全性和经济性。

Objective:To evaluate the safety,effectiveness and cost-effectiveness of icotinib for the treatment of non-small cell lung cancer(NSCLC)to meet the needs of decision makers.Methods:Several Chinese and English databases were searched systematically,such as PubMed,Cochrane,HTA database of every country,CNKI and Wanfang databases.Two evaluators extracted the data according to the inclusion and exclusion criteria and assessed the results.Results:A total of 9 systematic review/meta-analysis and 8 pharmacoeconomic studies were included.Icotinib could significantly extend the progression free survival(PFS)in patients with NSCLC when compared with erlotinib,gefitinib,pemetrexed based chemotherapy and pemetrexed free chemotherapy.However,when compared with osimertinib,dacomitinib,erlotinib+bevacizumab and gefitinib+pemetrexed based chemotherapy,icotinib significantly shortened the PFS in patients with NSCLC.The objective remission rate(ORR)of icotinib seemed to be higher than that of erlotinib in patients with NSCLC and was likely to be higher than that of the routine treatment or other drugs used for patients with NSCLC.In addition,icotinib plus taxol-platinum(TP)had higher ORR than TP alone.Compared with icotinib,osimertinib and gefitinib+pemetrexed based chemotherapy,icotinib showed longer overall survival(OS)in patients with NSCLC.Furthermore,icotinib and other epidermal growth factor receptor-tyrosine kinase inhibitor(EGFR-TKIs)(such as erlotinib,gefitinib,dacomitinib and afatinib)had similar OS.For patients with NSCLC,icotinib could significantly reduce the adverse reaction incidence(ADRs)when compared to erlotinib,gefitinib,routine treatment and other drugs.Compared with erlotinib+bevacizumab,pemetrexed based chemotherapy and pemetrexed free chemotherapy,icotinib had significantly lower Grade≥3 adverse events in patients with NSCLC.The involved pharmacoeconomic studies showed that icotinib had notable cost-effectiveness advantage when compared with erlotinib,gefitinib,pemetrexed and chemoradiotherapy alone.Conclusion:Icotinib has advantages of efficacy,safety and economy in the treatment of NSCLC.