曲妥珠单抗联合化疗治疗HER-2阳性胃癌的网状Meta分析

Mesh meta-analysis of trastuzumab combined with chemotherapy in the treatment of gastric cancer with HER-2 positive

目的 系统评价曲妥珠单抗(T-mab)联合化疗治疗人类表皮生长因子受体2(HER-2)阳性胃癌的临床有效性和安全性。方法 计算机检索中国知网、万方数据知识服务平台、中国生物医学文献数据库、维普网数据库与Cochrane Library, PubMed, Web of Science, Embase,检索时限从建库至2022年12月1日,搜集国内外公开发表的含T-mab分别联合奥沙利铂+替吉奥(SOX)、奥沙利铂+卡培他滨(XELOX)、顺铂+卡培他滨(XP)、顺铂+伊立替康(IP)、奥沙利铂+5-氟尿嘧啶+亚叶酸钙(FOLFOX)化疗方案治疗HER-2阳性胃癌的研究。采用RevMan 5.4软件进行偏倚评价,采用Stata 14.2软件进行网状Meta分析。结果 共纳入36篇文献,涉及3 003例患者。网状Meta分析结果显示:客观缓解率从高到低依次是T-mab+SOX、T-mab+FOLFOX、T-mab+XP、T-mab+XELOX、T-mab+IP、SOX、FOLFOX、XP、IP、XELOX;疾病控制率从高到低依次是T-mab+XELOX、T-mab+SOX、T-mab+XP、T-mab+FOLFOX、T-mab+IP、SOX、FOLFOX、XP、XELOX、IP;不良反应方面,T-mab+SOX恶心呕吐发生率最低,T-mab+FOLFOX肝毒性发生率最低,T-mab+XP神经毒性发生率最低,SOX骨髓抑制发生率最低。结论 现有证据表明,T-mab+SOX的客观缓解率相对最高,且兼具安全性,可能是最优方案。T-mab+XELOX疾病控制率相对最高,T-mab+IP的疗效相对最差,临床可根据患者自身情况酌情选用。

Objective To systematically evaluate the clinical efficacy and safety of trastuzumab(T-mab)combined with chemotherapy in the treatment of gastric cancer with human epidermal growth factor receptor 2(HER-2)positive.Methods Computer search of CNKI,Wanfang Data Knowledge Service Platform,China Biomedical Literature Database,VIP database,Cochrane Library,PubMed,Web of Science,Embase,the search period from inception to December 1,2022.To collect the published domestic and foreign studies in the treatment of HER-2 positive gastric cancer with T-mab combined with oxaliplatin+ticgor(SOX),oxaliplatin+capecitabine(XELOX),cisplatin+capecitabine(XP),cisplatin+irinotecan(IP),and oxaliplatin+5-fluorouracil+calcium folinate(FOLFOX)respectively.RevMan 5.4 software was used for bias assessment,and Stata 14.2 software was used for mesh meta-analysis.Results A total of 36 articles were included,involving 3003 patients.The results of mesh meta-analysis showed that the objective response rates from high to low were T-mab+SOX,T-mab+FOLFOX,T-mab+XP,T-mab+XELOX,T-mab+IP,SOX,FOLFOX,XP,IP,XELOX.The disease control rates from high to low were T-mab+XELOX,T-mab+SOX,T-mab+XP,T-mab+FOLFOX,T-mab+IP,SOX,FOLFOX,XP,XELOX,IP;In terms of adverse reactions,T-mab+SOX had the lowest incidence of nausea and vomiting,T-mab+FOLFOX had the lowest incidence of liver toxicity,T-mab+XP had the lowest incidence of neurotoxicity,SOX had the lowest incidence of myelosuppression.Conclusion Existing evidence shows that T-mab+SOX has the highest objective response rate and it is safe,which may be the optimal regimen.T-mab+XELOX has the highest disease control rate,while T-mab+IP has the worst efficacy,which can be selected according to patients′own conditions.