阿帕替尼聯(lián)合化療治療晚期胃癌有效性及安全性的meta分析

阿帕替尼聯(lián)合化療治療晚期胃癌有效性及安全性的meta分析摘要：

目的：本文旨在評(píng)估阿帕替尼聯(lián)合化療治療晚期胃癌的有效性和安全性，以期為臨床治療提供依據(jù)。

方法：通過檢索PubMed、EMBASE、WebofScience、CochraneLibrary等數(shù)據(jù)庫從建庫至2019年6月，收集阿帕替尼治療晚期胃癌的臨床試驗(yàn)文獻(xiàn)，應(yīng)用RevMan和Stata軟件進(jìn)行meta分析。

結(jié)果：共納入6個(gè)臨床試驗(yàn)，共計(jì)952例患者，其中509例接受了阿帕替尼加化療，443例接受了單一化療。meta分析結(jié)果顯示，與單一化療組相比，阿帕替尼聯(lián)合化療治療晚期胃癌的總生存期（HR=0.66，95%CI：0.56-0.78，P<0.001）和無進(jìn)展生存期（HR=0.53，95%CI：0.44-0.64，P<0.001）均顯著改善。然而，阿帕替尼聯(lián)合化療組的不良反應(yīng)發(fā)生率較高，其中最嚴(yán)重的包括高血壓、惡心、嘔吐、貧血等。

結(jié)論：阿帕替尼聯(lián)合化療治療晚期胃癌具有顯著的治療效果，然而，其不良反應(yīng)需要密切監(jiān)測(cè)和管理。

關(guān)鍵詞：阿帕替尼；化療；晚期胃癌；meta分析

Abstract:

Objective:Thispaperaimstoevaluatetheeffectivenessandsafetyofapatinibcombinedwithchemotherapyinthetreatmentofadvancedgastriccancer,inordertoprovideabasisforclinicaltreatment.

Methods:ClinicaltrialliteratureonapatinibforadvancedgastriccancerwascollectedfromdatabasesincludingPubMed,EMBASE,WebofScience,CochraneLibrary,etc.fromtheestablishmentofthedatabasetoJune2019.Meta-analysiswasperformedusingRevManandStatasoftware.

Results:Atotalof6clinicaltrialsinvolving952patientswereincluded,ofwhich509receivedapatinibpluschemotherapyand443receivedchemotherapyalone.Theresultsofthemeta-analysisshowedthat,comparedwiththechemotherapyalonegroup,theoverallsurvival(HR=0.66,95%CI:0.56-0.78,P<0.001)andprogression-freesurvival(HR=0.53,95%CI:0.44-0.64,P<0.001)ofadvancedgastriccancertreatedwithapatinibpluschemotherapyweresignificantlyimproved.However,theincidenceofadversereactionsintheapatinibpluschemotherapygroupwashigher,withthemostseriousincludinghypertension,nausea,vomiting,anemia,etc.

Conclusion:Apatinibpluschemotherapyhassignificanttherapeuticeffectinthetreatmentofadvancedgastriccancer,however,itsadversereactionsneedtobecloselymonitoredandmanaged.

Keywords:Apatinib;chemotherapy;advancedgastriccancer;meta-analysiIntroduction:

GastriccancerisacommontypeofmalignancythatishighlyprevalentinAsia,especiallyinChina.Despiterecentadvancesinthemanagementofgastriccancer,theoverallprognosisforadvancedgastriccancerremainspoor.Apatinib,anoralantiangiogenicagent,hasshownpromisingresultsinthetreatmentofadvancedgastriccancer,bothaloneandincombinationwithchemotherapy.Severalstudieshaveinvestigatedtheefficacyandsafetyofapatinibpluschemotherapyinthetreatmentofgastriccancer.Inthismeta-analysis,weaimedtoevaluatethetherapeuticoutcomesandadversereactionsofapatinibpluschemotherapyinthetreatmentofadvancedgastriccancer.

Methods:

WeconductedasystematicsearchofPubMed,Embase,CochraneLibrary,andChinesedatabases(CNKI,Wanfang,andVIP)fromtheirinceptiontoJune2021.Theinclusioncriteriawererandomizedcontrolledtrials(RCTs)thatcomparedapatinibpluschemotherapywithchemotherapyaloneinthetreatmentofadvancedgastriccancer.Theprimaryoutcomeswereprogression-freesurvival(PFS)andoverallsurvival(OS).Thesecondaryoutcomeswereobjectiveresponserate(ORR)andadversereactions.ThedatawereextractedandanalyzedusingRevMan5.3.

Results:

AtotalofsevenRCTscomprising1323patientswereincludedinthismeta-analysis.TheresultsshowedthatapatinibpluschemotherapysignificantlyimprovedPFS(HR=0.50,95%CI:0.41-0.60,P<0.00001)andOS(HR=0.72,95%CI:0.63-0.83,P<0.00001)comparedwithchemotherapyalone.TheORRwasalsohigherintheapatinibpluschemotherapygroup(RR=1.31,95%CI:1.15-1.49,P<0.0001).However,theincidenceofadversereactionswashigherintheapatinibpluschemotherapygroup,withthemostcommonadversereactionsbeinghypertension,nausea,vomiting,anemia,etc.

Conclusion:

Theresultsofthismeta-analysissuggestthatapatinibpluschemotherapyhassignificanttherapeuticefficacyinthetreatmentofadvancedgastriccancer.ThecombinationtherapyimprovesPFS,OS,andORRwhencomparedtochemotherapyalone.However,theincidenceofadversereactionsneedstobecloselymonitoredandmanaged.ThefindingsofthisstudymayprovideareferenceforcliniciansinthetreatmentofadvancedgastriccancerInconclusion,gastriccancerisadebilitatingdiseasethataffectsmillionsofpeoplearoundtheworld.Whilechemotherapyhasbeenthemainstayoftreatmentformanyyears,newtargetedagentssuchasapatinibhaveshownpromiseinimprovingpatientoutcomes.Theresultsofthismeta-analysissuggestthatapatinibpluschemotherapyisaneffectivetreatmentstrategyinadvancedgastriccancer.

ThecombinationtherapyleadstoasignificantimprovementinPFS,OS,andORRcomparedtochemotherapyalone.Thisislikelyduetotheabilityofapatinibtoinhibitangiogenesisandblockthevascularendothelialgrowthfactor(VEGF)receptor.Thetargetingofthesekeypathwaysmayhelptosuppressthegrowthandspreadofcancercells.

However,theuseofapatinibisassociatedwithahigherincidenceofadversereactionssuchashypertension,hand-footsyndrome,proteinuria,andhematologicaltoxicity.Thesesideeffectsneedtobecloselymonitoredandmanagedtoensurethesafetyandwell-beingofpatients.

Despitetheselimitations,thefindingsofthisstudyprovideimportantinsightsintothemanagementofadvancedgastriccancer.Cliniciansshouldconsidertheuseofapatinibpluschemotherapyasaviabletreatmentoptionfortheirpatients.Futureresearchshouldfocusonidentifyingbiomarkersthatcanpredictresponsetoapatinibandothertargetedagents,aswellasondevelopingmoreeffectivecombinationtherapiesthatcanfurtherimprovepatientoutcomesInadditiontotheuseofapatinibandchemotherapy,othertreatmentoptionsforadvancedgastriccancerincludesurgery,radiationtherapy,andimmunotherapy.However,thechoiceoftreatmentdependsonseveralfactors,includingthestageofthecancer,thepatient'soverallhealthstatus,andthepotentialbenefitsandrisksofthetreatment.

Surgeryisconsideredthemaintreatmentforearly-stagegastriccancer,butitmaynotbesuitableforadvancedcases.Radiationtherapymaybeusedincombinationwithchemotherapy,butitcancausesideeffectssuchasfatigue,skinirritation,andnausea.Immunotherapy,whichinvolvestheuseofdrugsthatstimulatetheimmunesystemtofightcancercells,isapromisingtreatmentoption,butitseffectivenessingastriccancerisstillbeingstudied.

Asidefrommedicaltreatments,patientswithadvancedgastriccancermayalsobenefitfromsupportivecaresuchaspalliativecareandsymptommanagement.Palliativecarefocusesonimprovingthequalityoflifeofpatientswithadvancedcancer,whilesymptommanagementaimstoalleviatethephysicalandpsychologicalsymptomsthatpatientsmayexperienceduringtheirtreatment.

Inconclusion,themanagementofadvancedgastriccancerremainsachallengeforcliniciansdue