表皮生长因子受体酪氨酸激酶抑制剂联合化疗一线治疗表皮生长因子受体突变晚期非小细胞肺癌疗效及安全性的Meta分析
R730.26; 背景 表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)的靶向治疗已成为表皮生长因子受体(EGFR)突变晚期非小细胞肺癌(NSCLC)的规范治疗方案,但临床发现了不可避免的原发性或继发性耐药最终导致了疾病进展.为此,寻找早期预测有效人群的标志物和探索延长或逆转继发性耐药的优化治疗方案成为国内外研究重点.目的 依据国内外文献数据系统评价EGFR-TKI联合化疗一线治疗EGFR突变晚期NSCLC的疗效及安全性.方法 计算机检索PubMed、Embase、Cochrane Library数据库发布的有关EGFR-TKI联合化疗对比单药EGFR-TKI一线治疗EGFR突变晚期NSC...
Saved in:
| Published in | 中国全科医学 Vol. 28; no. 11; pp. 1383 - 1394 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
050000 河北省石家庄市,河北医科大学第四医院肿瘤内科
15.04.2025
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1007-9572 |
| DOI | 10.12114/j.issn.1007-9572.2024.0351 |
Cover
| Abstract | R730.26; 背景 表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)的靶向治疗已成为表皮生长因子受体(EGFR)突变晚期非小细胞肺癌(NSCLC)的规范治疗方案,但临床发现了不可避免的原发性或继发性耐药最终导致了疾病进展.为此,寻找早期预测有效人群的标志物和探索延长或逆转继发性耐药的优化治疗方案成为国内外研究重点.目的 依据国内外文献数据系统评价EGFR-TKI联合化疗一线治疗EGFR突变晚期NSCLC的疗效及安全性.方法 计算机检索PubMed、Embase、Cochrane Library数据库发布的有关EGFR-TKI联合化疗对比单药EGFR-TKI一线治疗EGFR突变晚期NSCLC患者疗效及安全性的随机对照试验,检索时间为建库至2023年11月.由2名研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险,对无进展生存期(PFS)、总生存期(OS)、客观缓解率(ORR)、疾病控制率(DCR)以及≥3 级不良反应等数据收集和分析.基于基线临床特征进行亚组分析,使用RevMan 5.4.1 版本进行数据统计分析.结果 纳入符合条件的 10 项研究,共 2 029 例患者,其中EGFR-TKI联合化疗组 1 049 例患者,单纯EGFR-TKI组 980 例患者.Meta分析结果显示,与单纯EGFR-TKI组相比,EGFR-TKI联合化疗组可延长EGFR突变晚期NSCLC患者的PFS(HR=0.54,95%CI=0.49～0.60,P<0.000 01)和OS(HR=0.69,95%CI=0.59～0.79,P<0.000 01).与单纯EGFR-TKI组相比,EGFR-TKI联合化疗组可提高EGFR突变晚期NSCLC患者的ORR(OR=1.95,95%CI=1.57～2.42,P<0.000 01)和DCR(OR=1.76,95%CI=1.13～2.74,P=0.01).在伴随脑转移的患者中,与单纯EGFR-TKI治疗相比,EGFR-TKI联合化疗延长EGFR突变晚期NSCLC患者的PFS(HR=0.42,95%CI=0.34～0.52,P<0.000 01)和OS(HR=0.69,95%CI=0.51～0.94,P=0.02).在基线无脑转移的患者中,与单纯EGFR-TKI治疗相比,EGFR-TKI联合化疗延长EGFR突变晚期NSCLC患者的PFS(HR=0.62,95%CI=0.53～0.72,P< |
|---|---|
| AbstractList | R730.26; 背景 表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)的靶向治疗已成为表皮生长因子受体(EGFR)突变晚期非小细胞肺癌(NSCLC)的规范治疗方案,但临床发现了不可避免的原发性或继发性耐药最终导致了疾病进展.为此,寻找早期预测有效人群的标志物和探索延长或逆转继发性耐药的优化治疗方案成为国内外研究重点.目的 依据国内外文献数据系统评价EGFR-TKI联合化疗一线治疗EGFR突变晚期NSCLC的疗效及安全性.方法 计算机检索PubMed、Embase、Cochrane Library数据库发布的有关EGFR-TKI联合化疗对比单药EGFR-TKI一线治疗EGFR突变晚期NSCLC患者疗效及安全性的随机对照试验,检索时间为建库至2023年11月.由2名研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险,对无进展生存期(PFS)、总生存期(OS)、客观缓解率(ORR)、疾病控制率(DCR)以及≥3 级不良反应等数据收集和分析.基于基线临床特征进行亚组分析,使用RevMan 5.4.1 版本进行数据统计分析.结果 纳入符合条件的 10 项研究,共 2 029 例患者,其中EGFR-TKI联合化疗组 1 049 例患者,单纯EGFR-TKI组 980 例患者.Meta分析结果显示,与单纯EGFR-TKI组相比,EGFR-TKI联合化疗组可延长EGFR突变晚期NSCLC患者的PFS(HR=0.54,95%CI=0.49～0.60,P<0.000 01)和OS(HR=0.69,95%CI=0.59～0.79,P<0.000 01).与单纯EGFR-TKI组相比,EGFR-TKI联合化疗组可提高EGFR突变晚期NSCLC患者的ORR(OR=1.95,95%CI=1.57～2.42,P<0.000 01)和DCR(OR=1.76,95%CI=1.13～2.74,P=0.01).在伴随脑转移的患者中,与单纯EGFR-TKI治疗相比,EGFR-TKI联合化疗延长EGFR突变晚期NSCLC患者的PFS(HR=0.42,95%CI=0.34～0.52,P<0.000 01)和OS(HR=0.69,95%CI=0.51～0.94,P=0.02).在基线无脑转移的患者中,与单纯EGFR-TKI治疗相比,EGFR-TKI联合化疗延长EGFR突变晚期NSCLC患者的PFS(HR=0.62,95%CI=0.53～0.72,P< |
| Abstract_FL | Background Targeted therapy with epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)has become a standardized treatment option for epidermal growth factor receptor(EGFR)mutation-positive advanced non-small cell lung cancer(NSCLC),but clinical findings of unavoidable primary or secondary resistance ultimately lead to disease progression.For this reason,finding markers for early prediction of effective populations and exploring optimized therapeutic regimens to prolong or reverse secondary resistance have become the focus of research at home and abroad.Objective To systematically evaluate the efficacy and safety of EGFR-TKI combined with chemotherapy for the first-line treatment of EGFR-mutated advanced non-small cell lung cancer based on data from domestic and international literature.Methods Three professionally recognized databases,PubMed,Embase,and Cochrane Library,were searched for randomized controlled trials eligible for the efficacy and safety of EGFR-TKI combination chemotherapy versus single-agent EGFR-TKI for the first-line treatment of patients with EGFR-mutated advanced non-small-cell lung cancer published from the time of construction to November 2023.Data on progression-free survival(PFS),overall survival(OS),objective remission rate(ORR),disease control rate(DCR),and grade≥3 adverse events were collected and analyzed by two investigators who independently screened the literature,extracted the data,and evaluated the risk of bias of the included studies.Subgroup analyses were performed based on baseline clinical characteristics,and data were statistically analyzed using RevMan 5.4.1.Results Ten eligible studies with a total of 2 029 patients were included,including 1 049 patients in the experimental group of EGFR-TKI combined with standard chemotherapy;and 980 patients in the control group of EGFR-TKI alone.Meta-analysis showed that compared with EGFR-TKI monotherapy,EGFR-TKI combination chemotherapy prolonged PFS(HR=0.54,95%CI=0.49-0.60,P<0.000 01)and OS(HR=0.69,95%CI=0.59-0.79,P<0.000 01).Compared with EGFR-TKI monotherapy,EGFR-TKI combination chemotherapy improved ORR(OR=1.95,95%CI=1.57-2.42,P<0.000 01)and DCR(OR=1.76,95%CI=1.13-2.74,P=0.01)in patients with advanced NSCLC with EGFR mutations.In patients with concomitant brain metastases,EGFR-TKI combination chemotherapy prolonged PFS(HR=0.42,95%CI=0.34-0.52,P<0.000 01)and OS(HR=0.69,95%CI=0.51-0.94,P=0.02)in patients with EGFR-mutated advanced NSCLC compared with single-agent EGFR-TKI treatment.In patients without brain metastases at baseline,EGFR-TKI combination chemotherapy prolonged PFS compared with single-agent EGFR-TKI treatment in patients with advanced NSCLC with EGFR mutations(HR=0.62,95%CI=0.53-0.72,P<0.000 01).The incidence of grade≥3 adverse reactions was higher with EGFR-TKI combination chemotherapy than with single-agent EGFR-TKI treatment in patients with advanced NSCLC with EGFR mutations(OR=4.25,95%CI=2.74-6.61,P<0.000 01).The incidence of grade≥3 adverse reactions was higher in the combination therapy group than in the monotherapy group.Conclusion EGFR-TKI combination chemotherapy significantly prolongs first-line PFS and OS in EGFR-mutated advanced non-small cell lung cancer,especially in patients with baseline brain metastases.The incidence of adverse events was increased in the combination therapy group,particularly the incidence of grade≥3 hematologic toxicity,but was overall safe and manageable. |
| Author | 王亚静 史健 侯冉 黄娅婕 段晓阳 |
| AuthorAffiliation | 050000 河北省石家庄市,河北医科大学第四医院肿瘤内科 |
| AuthorAffiliation_xml | – name: 050000 河北省石家庄市,河北医科大学第四医院肿瘤内科 |
| Author_FL | HOU Ran HUANG Yajie SHI Jian DUAN Xiaoyang WANG Yajing |
| Author_FL_xml | – sequence: 1 fullname: SHI Jian – sequence: 2 fullname: WANG Yajing – sequence: 3 fullname: HOU Ran – sequence: 4 fullname: HUANG Yajie – sequence: 5 fullname: DUAN Xiaoyang |
| Author_xml | – sequence: 1 fullname: 史健 – sequence: 2 fullname: 王亚静 – sequence: 3 fullname: 侯冉 – sequence: 4 fullname: 黄娅婕 – sequence: 5 fullname: 段晓阳 |
| BookMark | eNp1UE1LAkEAnYNBVv6KDp3cZmZ3XPcY0hcYXeos6-6saLFSW_RxUktRETTyIy21TomQSAcRJfwzzqz7L1oounV6H_Deg7cCPGbSpACsIyggjJC0mRDilmUKCELZrxAZCxhiSYAiQR7g_XOXgc-y4lFXSkRGRPGC9uKtZ7cGdrXr1Gbs-ZV9VFi5Mf96dLJ9Puw52TGfpZzsiBcfWH7ECplFusoqeVaq2_XGfJyyJzP-OXX5fz12P83KT7zZ4i9dp91hw7I9zS3uOovMxG6W3CCv5Vm5yAYFlu3x1Lvduj-gFyrL53insgaWDPXUor5fXAXHO9tHoT1_-HB3P7QV9lsIYuKnohrUqSTJBEcxjSqSoelGVBUloiEiUU3TFS2AEA1AgxiGhokGZUiDuqoHZKwQKq6CjZ_eK9U0VDMWSSQvz013MXIbOzu5uXbPJAhBRMRvZuinKQ |
| ClassificationCodes | R730.26 |
| ContentType | Journal Article |
| Copyright | Copyright © Wanfang Data Co. Ltd. All Rights Reserved. |
| Copyright_xml | – notice: Copyright © Wanfang Data Co. Ltd. All Rights Reserved. |
| DBID | 2B. 4A8 92I 93N PSX TCJ |
| DOI | 10.12114/j.issn.1007-9572.2024.0351 |
| DatabaseName | Wanfang Data Journals - Hong Kong WANFANG Data Centre Wanfang Data Journals 万方数据期刊 - 香港版 China Online Journals (COJ) China Online Journals (COJ) |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| DocumentTitle_FL | Efficacy and Safety of EGFR-TKI Combined with Chemotherapy for the First-line Treatment of EGFR-mutated Advanced Non-small Cell Lung Cancer:a Meta-analysis |
| EndPage | 1394 |
| ExternalDocumentID | zgqkyx202511015 |
| GrantInformation_xml | – fundername: 河北省科技厅自然基金处项目 funderid: (S2018206002) |
| GroupedDBID | -05 2B. 4A8 92F 92I 93N ABJNI ACGFS ALMA_UNASSIGNED_HOLDINGS CCEZO CIEJG CW9 GROUPED_DOAJ PSX TCJ TGQ U1G U5O |
| ID | FETCH-LOGICAL-s1025-e3a8de44752b2eb94fcdfba345c154eccd9c611e60f5ffc25c070e8dad67295e3 |
| ISSN | 1007-9572 |
| IngestDate | Thu May 29 04:06:51 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 11 |
| Keywords | 表皮生长因子受体酪氨酸激酶抑制剂 Non-small cell lung cancer 表皮生长因子受体突变 Epidermal growth factor receptor tyrosine kinase inhibitors Meta分析 非小细胞肺癌 Combination therapy Epidermal growth factor receptor mutations 联合治疗 Meta-analysis |
| Language | Chinese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-s1025-e3a8de44752b2eb94fcdfba345c154eccd9c611e60f5ffc25c070e8dad67295e3 |
| PageCount | 12 |
| ParticipantIDs | wanfang_journals_zgqkyx202511015 |
| PublicationCentury | 2000 |
| PublicationDate | 2025-04-15 |
| PublicationDateYYYYMMDD | 2025-04-15 |
| PublicationDate_xml | – month: 04 year: 2025 text: 2025-04-15 day: 15 |
| PublicationDecade | 2020 |
| PublicationTitle | 中国全科医学 |
| PublicationTitle_FL | Chinese General Practice |
| PublicationYear | 2025 |
| Publisher | 050000 河北省石家庄市,河北医科大学第四医院肿瘤内科 |
| Publisher_xml | – name: 050000 河北省石家庄市,河北医科大学第四医院肿瘤内科 |
| SSID | ssib007457159 ssj0058485 ssib007693709 ssib017477037 ssib007457160 ssib007457161 ssib001103591 ssib051368463 |
| Score | 2.4187872 |
| Snippet | R730.26; 背景 表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)的靶向治疗已成为表皮生长因子受体(EGFR)突变晚期非小细胞肺癌(NSCLC)的规范治疗方案,但临床发现了不可避免的... |
| SourceID | wanfang |
| SourceType | Aggregation Database |
| StartPage | 1383 |
| Title | 表皮生长因子受体酪氨酸激酶抑制剂联合化疗一线治疗表皮生长因子受体突变晚期非小细胞肺癌疗效及安全性的Meta分析 |
| URI | https://d.wanfangdata.com.cn/periodical/zgqkyx202511015 |
| Volume | 28 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| journalDatabaseRights | – providerCode: PRVAON databaseName: DOAJ Directory of Open Access Journals issn: 1007-9572 databaseCode: DOA dateStart: 20220101 customDbUrl: isFulltext: true dateEnd: 99991231 titleUrlDefault: https://www.doaj.org/ omitProxy: true ssIdentifier: ssj0058485 providerName: Directory of Open Access Journals |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV3daxNBED9KBfFFFBW_Keg-SeJ97-7jXnqhCPrUgm-Su1wUhIpaQftUqylpKaSitrZqq08WQREfRFqk_4t4l-S_cGbuLjml4gdCCHM7m9mZ3-xmZ_budjXtrGhYgkPaVZIQD5RgJBol3JOkpAc1XrdsaTl0dMLFS-7YhH3hsnN5aPhr4amlO1NBOZze9b2Sf_EqlIFf8S3Zv_BsXygUAA3-hW_wMHz_kY-ZL5gymBLM50wqpnwibCarzJdMOswDwmHSY0pHQo0ySYSoMsmZbzMPSiysLICrmO8yTyeBVOIJKqni8xBZiYslQjFpkBxBJUAA10R9hIEKYKM6cpFVYdIlxdy8UUECOfMUaQhNmMzzCnX-l10cjRJGziJzpESZSFRygVDZxzpgO1RDxTwmXDLHIpZA60BbVEOiRQNVXdQns7SKyKA-PgKCJQ5Z4aK9imfmCPtiBEF7Cp8gQKGN9DzTPFHIYALDUju90YI4jrIyB1QIOIJA9VdZM2UAVSQASWfA4UyAdh41oAiJFAA5qAIcnymCGNQTBY4kZMi_oAiogwR6pLh6ZDp4Iyx9f5bGu47nYejnckdbea9IAamQgzj6ImUBemmn8lTWlkf4m5XdJPQxKKCibEI7Q4VYFfykWEqv8CuJDlVm7mLyPvQTZefWO33JhQkcl96lw3-Y4U1R_CczCvO1YaXHKGWxH6RD9q5xhWkYNgUW2Ei530gZILXLeDN-EE71H3Kdvnrz-r27JiXxOu6DsceEyEMvLPtQymLgJpqDOZbbDi-mGHRdWMJIrwv1XUgwBlvwGdzmMIn3UwrHsFxBJ16k0SnkG3RMcd-EvdqZ3MDzvzaPXmmcbNQmrxai7_ED2v4sbR5R6X_gQW1o-toh7WX39WZn7X3nyUbv6U78_FX8bilur3z78rjXfJt82Ow1Pyc7M73mp2ThUdz6FM_Pdu8_iZda8eJyZ3nl2-eZztZO8nEb6F_J6by9H7efJatryYuN3sv1-EO7sz3XfbDend3qrC7CD5Onrbi9EL-fj5ubycybztpDHNlxay5ZXzqsTVT98cpYKTtupnTbwJERWTVRj3ADVDMwo0DajbDeCGqW7YSQZ8JUV5ehaxiRqzecRiM0nRDCpUjUa3WXm9KJrCPa8OSNyeioNmIFYS0wLR5Iw8YTMWSIx5Q0Aqdm1iO3Hh7TRjI4r2TTye0rP3WX47-vckLbNxjSJ7XhqVt3olOQIk0Fp6mPfQfoeyVF |
| linkProvider | Directory of Open Access Journals |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E8%A1%A8%E7%9A%AE%E7%94%9F%E9%95%BF%E5%9B%A0%E5%AD%90%E5%8F%97%E4%BD%93%E9%85%AA%E6%B0%A8%E9%85%B8%E6%BF%80%E9%85%B6%E6%8A%91%E5%88%B6%E5%89%82%E8%81%94%E5%90%88%E5%8C%96%E7%96%97%E4%B8%80%E7%BA%BF%E6%B2%BB%E7%96%97%E8%A1%A8%E7%9A%AE%E7%94%9F%E9%95%BF%E5%9B%A0%E5%AD%90%E5%8F%97%E4%BD%93%E7%AA%81%E5%8F%98%E6%99%9A%E6%9C%9F%E9%9D%9E%E5%B0%8F%E7%BB%86%E8%83%9E%E8%82%BA%E7%99%8C%E7%96%97%E6%95%88%E5%8F%8A%E5%AE%89%E5%85%A8%E6%80%A7%E7%9A%84Meta%E5%88%86%E6%9E%90&rft.jtitle=%E4%B8%AD%E5%9B%BD%E5%85%A8%E7%A7%91%E5%8C%BB%E5%AD%A6&rft.au=%E5%8F%B2%E5%81%A5&rft.au=%E7%8E%8B%E4%BA%9A%E9%9D%99&rft.au=%E4%BE%AF%E5%86%89&rft.au=%E9%BB%84%E5%A8%85%E5%A9%95&rft.date=2025-04-15&rft.pub=050000+%E6%B2%B3%E5%8C%97%E7%9C%81%E7%9F%B3%E5%AE%B6%E5%BA%84%E5%B8%82%2C%E6%B2%B3%E5%8C%97%E5%8C%BB%E7%A7%91%E5%A4%A7%E5%AD%A6%E7%AC%AC%E5%9B%9B%E5%8C%BB%E9%99%A2%E8%82%BF%E7%98%A4%E5%86%85%E7%A7%91&rft.issn=1007-9572&rft.volume=28&rft.issue=11&rft.spage=1383&rft.epage=1394&rft_id=info:doi/10.12114%2Fj.issn.1007-9572.2024.0351&rft.externalDocID=zgqkyx202511015 |
| thumbnail_s | http://utb.summon.serialssolutions.com/2.0.0/image/custom?url=http%3A%2F%2Fwww.wanfangdata.com.cn%2Fimages%2FPeriodicalImages%2Fzgqkyx%2Fzgqkyx.jpg |