厄洛替尼治療老年非小細胞肺癌的系統評價_《中國循證醫學雜志》

作者：

占美 , 劉瀟 , 盧靜 ,  徐珽

四川大學華西醫院藥劑科（成都 610041）;

關鍵詞：

厄洛替尼非小細胞肺癌老年系統評價 Meta分析

DOI：

10.7507/1672-2531.20130186

視頻：

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目的　系統評價厄洛替尼治療非小細胞肺癌老年患者的療效及安全性。
方法　電子檢索Cochrane圖書館、PubMed、EMbase、CBM、VIP、CNKI和WanFang Data。由2位研究者按照納入與排除標準獨立進行文獻篩選、資料提取和方法學質量評價后，采用RevMan 5.0軟件進行Meta分析。
結果　共納入5個RCT，493例患者。Meta分析結果顯示：厄洛替尼組的反應率和疾病控制率與對照組相似，其差異無統計學意義［RR=0.99，95%CI（0.34，2.93），P=0.99；RR=1.17，95%CI（0.95，1.43），P=0.14］。厄洛替尼組Ⅲ～Ⅳ度中性粒細胞和血小板降低的發生率低于對照組［OR=0.12，95%CI（0.03，0.52），P=0.005；OR=0.19，95%CI（0.04，0.91），P=0.04］；兩組Ⅲ～Ⅳ度惡心嘔吐和肝功能損傷的發生率相似［OR=0.93，95%CI（0.12，7.08），P=0.95；OR=0.80，95%CI（0.24，2.68），P=0.71］；厄洛替尼組腹瀉和皮疹的發生率高于對照組［OR=5.96，95%CI（1.28，27.88），P=0.02；OR=6.77，95%CI（1.52，30.10），P=0.01］。
結論　當前證據顯示，厄洛替尼治療老年非小細胞肺癌患者療效確切，嚴重不良反應的發生率低，患者耐受較好。受限于納入研究數量和質量，上述結論有待更多高質量大樣本長期隨訪的研究予以驗證。

引用本文： 占美,劉瀟,盧靜,徐珽. 厄洛替尼治療老年非小細胞肺癌的系統評價. 中國循證醫學雜志, 2013, 13(9): 1084-1089. doi: 10.7507/1672-2531.20130186 復制

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11.	Wheatley-Price P, Ding K, Seymour L, et al. Erlotinib for advanced non-small-cell lung cancer in the elderly: an analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol, 2008, 26(14): 2350-2357.
12.	Stinchcombe TE, Peterman AH, Lee CB, et al. A randomized phase II trial of first-line treatment with gemcitabine, erlotinib, or gemcitabine and erlotinib in elderly patients (age >/=70 years) with stage IIIB/IV non-small cell lung cancer. J Thorac Oncol, 2011, 6(9): 1569-1577.
13.	Gridelli C, Morgillo F, Favaretto A, et al. Sorafenib in combination with erlotinib or with gemcitabine in elderly patients with advanced non-small-cell lung cancer: a randomized phase II study. Ann Oncol, 2011, 22(7): 1528-1534.
14.	Chen YM, Tsai CM, Fan WC, et al. Phase II randomized trial of erlotinib or vinorelbine in chemonaive, advanced, non-small cell lung cancer patients aged 70 years or older. J Thorac Oncol, 2012, 7(2): 412-418.
15.	Cadranel J, Mauguen A, Faller M, et al. Impact of systematic EGFR and KRAS mutation evaluation on progression-free survival and overall survival in patients with advanced non-small-cell lung cancer treated by erlotinib in a French prospective cohort (ERMETIC project–part 2). J Thorac Oncol, 2012, 7(10): 1490-1502.
16.	Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. The Lancet Oncology, 2011, 12(8): 735-742.
17.	關兵, 周丹, 劉麗華, 等. 非小細胞肺癌醫療費用研究. 中國循證醫學雜志, 2008, 8(11): 1012-1015.
18.	Ettinger D, Akerley W, Borghaei H. NCCN Clinical Practice Guidelines in Oncology: Non–Small Cell Lung Cancer. Version 2, 2012.
19.	Gridelli C, Langer C, Maione P, et al. Lung cancer in the elderly. Journal of Clinical Oncology, 2007, 25(14): 1898-1907.
20.	Gridelli C, Shepherd FA. Chemotherapy for Elderly Patients With Non-Small Cell Lung Cancer. Chest, 2005, 128(2): 947-957.
21.	Gordon HG, Andrew DO, Victor M, et al. Grade指南證據質量評價——發表偏倚. 中國循證醫學雜志, 2011, 11(12): 1430-1434.

1. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer, 1997, 80(7): 1273-1283.
2. Bunn Jr PA, Lilenbaum R. Chemotherapy for elderly patients with advanced non-small-cell lung cancer. Journal of the National Cancer Institute, 2003, 95(5): 341-343.
3. Gridelli C, Langer C, Maione P, et al. Lung cancer in the elderly. Journal of Clinical Oncology, 2007, 25(14): 1898-1907.
4. 王瑾, 許峰, 周清華. 肺癌流行病學研究進展. 中國肺癌雜志, 2005, 8(005): 395-400.
5. 王應強, 王莉, 李幼平, 等. 江蘇省高郵市送橋中心衛生院2010年住院疾病與費用構成調查. 中國循證醫學雜志, 2012, 12(2): 148-155.
6. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol, 2012, 13(3): 239-246.
7. Gridelli C, Ciardiello F, Gallo C, et al. First-line erlotinib followed by second-line cisplatin-gemcitabine chemotherapy in advanced non-small-cell lung cancer: the TORCH randomized trial. Journal of Clinical Oncology, 2012, 30(24): 3002-3011.
8. Cascinu S, Del Ferro E, Catalano G. Toxicity and therapeutic response to chemotherapy in patients aged 70 years or older with advanced cancer. Am J Clin Oncol, 1996, 19(4): 371-374.
9. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0. 2 [updated September 2009]. The Cochrane Collaboration, 2009. Available from: www.cochrane-handbook.org.2010.
10. 樊衛飛, 王峻, 孟麗娟, 等. 厄洛替尼一線治療老年晚期非小細胞肺癌臨床觀察. 腫瘤學雜志. 2012, 18(3): 174-177.
11. Wheatley-Price P, Ding K, Seymour L, et al. Erlotinib for advanced non-small-cell lung cancer in the elderly: an analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21. J Clin Oncol, 2008, 26(14): 2350-2357.
12. Stinchcombe TE, Peterman AH, Lee CB, et al. A randomized phase II trial of first-line treatment with gemcitabine, erlotinib, or gemcitabine and erlotinib in elderly patients (age >/=70 years) with stage IIIB/IV non-small cell lung cancer. J Thorac Oncol, 2011, 6(9): 1569-1577.
13. Gridelli C, Morgillo F, Favaretto A, et al. Sorafenib in combination with erlotinib or with gemcitabine in elderly patients with advanced non-small-cell lung cancer: a randomized phase II study. Ann Oncol, 2011, 22(7): 1528-1534.
14. Chen YM, Tsai CM, Fan WC, et al. Phase II randomized trial of erlotinib or vinorelbine in chemonaive, advanced, non-small cell lung cancer patients aged 70 years or older. J Thorac Oncol, 2012, 7(2): 412-418.
15. Cadranel J, Mauguen A, Faller M, et al. Impact of systematic EGFR and KRAS mutation evaluation on progression-free survival and overall survival in patients with advanced non-small-cell lung cancer treated by erlotinib in a French prospective cohort (ERMETIC project–part 2). J Thorac Oncol, 2012, 7(10): 1490-1502.
16. Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. The Lancet Oncology, 2011, 12(8): 735-742.
17. 關兵, 周丹, 劉麗華, 等. 非小細胞肺癌醫療費用研究. 中國循證醫學雜志, 2008, 8(11): 1012-1015.
18. Ettinger D, Akerley W, Borghaei H. NCCN Clinical Practice Guidelines in Oncology: Non–Small Cell Lung Cancer. Version 2, 2012.
19. Gridelli C, Langer C, Maione P, et al. Lung cancer in the elderly. Journal of Clinical Oncology, 2007, 25(14): 1898-1907.
20. Gridelli C, Shepherd FA. Chemotherapy for Elderly Patients With Non-Small Cell Lung Cancer. Chest, 2005, 128(2): 947-957.
21. Gordon HG, Andrew DO, Victor M, et al. Grade指南證據質量評價——發表偏倚. 中國循證醫學雜志, 2011, 11(12): 1430-1434.

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厄洛替尼治療老年非小細胞肺癌的系統評價

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厄洛替尼治療老年非小細胞肺癌的系統評價

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