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贝伐珠单抗联合化疗/EGFR-TKI治疗晚期肺癌安全性的Meta分析

Safety of Bevacizumab Combined with Chemotherapy/EGFR TKI in the Treatment of Advanced Lung Cancer: A Meta Analysis

DOI：

中文关键词: 晚期肺癌贝伐珠单抗化疗表皮生长因子受体酪氨酸激酶抑制药 Meta分析安全性

英文关键词:Advanced lung cancer Bevacizumab Chemotherapy EGFR TKI Meta analysis Safety

基金项目:2013年四川省卫生厅立项科研课题（编号：130388）

作者	单位
郑玲利¹ 袁明勇¹ 蒋婷¹ 袁婷²	1.成都医学院第一附属医院成都 610500；2.成都医学院

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中文摘要:

摘要目的：采用Meta分析方法评价贝伐珠单抗联合化疗/表皮生长因子受体酪氨酸激酶抑制药（EGFR TKI）治疗晚期肺癌的安全性。方法：检索PubMed、Embase、Cochrane Library、Web of Science、CNKI、SinoMed、VIP以及万方数据库，搜集贝伐珠单抗联合化疗/EGFR TKI治疗晚期肺癌的随机对照试验（RCTs），同时，追溯纳入研究的参考文献，进一步扩大检索。对符合纳入标准的RCTs，采用RevMan 5.1软件进行Meta分析。结果：共纳入9篇英文文献11项研究（其中2篇文献分别包含2项独立研究），共3 892例患者。Meta分析结果显示：与化疗/EGFR TKI相比，贝伐珠单抗联合化疗/EGFR TKI增加了患者≥3级高血压（RR=5.92，95%CI：3.53~9.93，P＜0.000 01）、≥3级蛋白尿（RR=8.11，95%CI：2.57~25.60，P=0.000 4）、≥3级出血事件（RR=2.41，95%CI：1.51~3.86，P=0.000 3）、≥3级血栓栓塞事件（RR=1.62，95%CI：1.08~2.43，P=0.02）发生风险，未增加患者致死性不良事件（RR=2.69，95%CI：0.76~9.54，P=0.13）发生风险。亚组分析结果显示：贝伐珠单抗7.5 mg·kg-1未增加患者≥3级蛋白尿（RR=2.11，95%CI：0.23~19.58，P=0.51）、≥3级血栓栓塞事件（RR=1.33，95%CI：0.76~2.34，P=0.31）发生风险。结论：贝伐珠单抗联合化疗/EGFR TKI增加了患者高血压、蛋白尿、出血事件、血栓栓塞事件的发生风险，但未增加致死性不良事件发生风险，而7.5 mg·kg-1贝伐珠单抗联合化疗/EGFR TKI可能具有更高的安全性。

英文摘要:

ABSTRACT Objective:To evaluate the safety of bevacizumab combined with chemotherapy/EGFR TKI in the treatment of advanced lung cancer. Methods:Search PubMed, Embase, Cochrane Library, Web of Science, CNKI, SinoMed, VIP and Wanfang Database, included in relevant literature references to further broaden the search. Randomized controlled studies (RCTs) consistent with inclusion criteria were performed using RevMan 5.1 for Meta analysis. Results: A total of 11 studies were included in 9 English literatures (2 of which included 2 independent studies), and 3 892 patients were included. Combined with bevacizumab could increased the risk of ≥3 hypertension (RR=5.92, 95%CI: 3.53 9.93, P <0.000 01), ≥3 proteinuria (RR=8.11, 95%CI: 2.57 25.60, P=0.000 4), ≥3 bleeding (RR=2.41, 95%CI: 1.51 3.86, P=0.000 3), ≥3 thrombotic events (RR=1.62, 95%CI: 1.08 2.43, P=0.02) , did not increase a risk of fatal events (RR=2.69, 95%CI: 0.76 9.54, P=0.13). Subgroup analysis showed that combined with bevacizumab 7.5 mg·kg-1 did not increase the patients with ≥3 proteinuria (RR=2.11, 95%CI: 0.23 19.58, P=0.51), ≥3 thromboembolic events (RR=1.33, 95%CI: 0.76 2.34, P=0.31). Conclusion:Bevacizumab combined with chemotherapy/EGFR TKI increased the risks of hypertension, proteinuria, bleeding events and thrombotic events, but did not increase the risk of fatal adverse events, whereas chemotherapy/EGFR TKI combined with bevacizumab 7.5mg·kg-1 may have a higher level of safety.

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