培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的Meta分析_《中国循证医学杂志》

作者：

姜金 ^1,2 , 王晓晶 ^1,2 , 张璐 ^1,2 , 林乔 ^1,2 , 陈淼 ^1,2 ,  田金徽 ¹

1. 兰州大学循证医学中心，兰州大学基础医学院（兰州?730000）；2. 兰州大学第二临床医学院（兰州?730000）;

关键词：

培美曲塞多西紫杉醇晚期非小细胞肺癌系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20110160

视频：

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目的　系统评价培美曲塞与多西紫杉醇治疗晚期非小细胞肺癌（NSCLC）的疗效与安全性。
方法　计算机检索Cochrane Library、PubMed、EMbase、SCI、CBM、CNKI和VIP，同时辅助其他检索方式，纳入培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的临床随机对照试验，检索时间截至2010年11月。由两位研究者独立进行文献筛选、资料提取和方法学质量评价后，采用RevMan 5.0软件进行Meta分析。
结果　共纳入5个研究，合计847例患者。Meta分析结果显示：在疗效方面，培美曲塞与多西紫杉醇相比，两者在有效率［OR=1.09，95%CI（0.7，1.70）］、疾病控制率［OR=0.99，95%CI（0.75，1.31）］、1年生存率［OR=1.11，95%CI（0.56，2.18）］等方面差异无统计学意义；在安全性方面，与多西紫杉醇相比，培美曲塞可降低中性粒细胞减少［OR=0.09，95%CI（0.05，0.15）］和粒细胞性发热［OR=0.13，95%CI（0.06，0.29）］、减少脱发［OR=0.20，95%CI（0.12，0.33）］，而在血红蛋白［OR=1.45，95%CI（0.23，9.06）］、血小板减少［OR=1.46，95%CI（0.59，3.59）］、恶心呕吐［OR=1.23，95%CI（0.53，2.83）］、疲劳乏力［OR=0.73，95%CI（0.40，1.30）］等方面两者差异无统计学意义。
结论　当前证据显示，培美曲塞与多西紫杉醇治疗晚期NSCLC的疗效相当，但可减少中性粒细胞减少、粒细胞性发热和脱发等不良反应。

引用本文： 姜金,王晓晶,张璐,林乔,陈淼,田金徽. 培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的Meta分析. 中国循证医学杂志, 2011, 11(8): 960-964. doi: 10.7507/1672-2531.20110160 复制

1.	2 Novello S, Le Chevaller T. Chemotherapy for non-small-cell lung cancer. Part 1: Early-stage disease. Oncology (Williston Park) , 2003, 17(3): 357-364.
2.	National Cancer Institute SEER data. [2009-06-20]. Available at: http: //seer. cancer. gov/statistics/.
3.	Socinski MA, Morris DE, Masters GA, et al . Chemotherapeutic Managenment of Stage Ⅳ Non-small Cell Lung Cancer. Chest , 2003, 123(1 Suppl): 226S-243S.
4.	Di Maio M, Chiodini P, Georgoulias V, et al . Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second line treatment of advanced non-small-cell lung cancer. J Clin Oncol , 2009, 27(11): 1836-1843.
5.	NCCN非小细胞肺癌临床实践指南专家组. 肿瘤学临床实践指南(中国版). 第1版. 2008: 20-21.
6.	Ciuleanu T, Brodowicz T, Zielinski C, et al . Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet , 2009, 374(9699): 1432-1440.
7.	母连军. 培美曲塞获准作为非小细胞肺癌治疗的一线药. 国外医药抗生素分册, 2008, 29(6): 285-286.
8.	刘宝. 4种非小细胞肺癌二线药物治疗方案费用比较研究. 中国药房, 2010, 21(26): 2303-2406.
9.	Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Review of Inerventions Version 5. 0. 0(update February 2008). The Cochrane Collaboration, 2008. Available from www. cochrane-handbook. org.
10.	陈墨, 周彩存, 张洁. 力比泰与泰素帝治疗非小细胞肺癌临床疗比较. 同济大学(医学版), 2008, 29(3): 54-57.
11.	胡广原, 梅齐, 熊慧华, 等. 培美曲塞二钠单药对比多西紫杉醇二线治疗晚期非小细胞肺癌临床观察. 临床荟萃, 2009, 24(13): 1166-1168.
12.	孟丽娟, 王峻, 刘福银, 等. 老年晚期非小细胞肺癌单药二线培美曲塞或多西他赛治疗的临床观察. 实用老年医学, 2010, 24(1): 66-68.
13.	冯永, 仲琴, 贾正飞, 等. 培美曲塞、多西紫杉醇治疗晚期非小细胞肺癌的疗效比较. 山东医药, 2010, 50(37): 53-54.
14.	Hanna N, Shepherd FA, Fossella FV, et al . Randomized Phase Ⅲ Trial of Pemetrexed Versus Docetaxel in Patients With Non-Small-Cell Lung Cancer Previously Treated With Chemotherapy. J Clin Oncol , 2004, 22(9): 1589-1597.
15.	Shepherd FA, Dancey J, Ramlau R, et al . prospective randomized trial of docetaxel versus best supportive care in patients with non-small cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol , 2000, 18(10): 2095-2103.
16.	Fossella F, DeVore R, Kerr R, et al . Randomized phase Ⅲ trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small cell lung cancer previously treated with platinum-containing chemotherapy regimens The TAX 320 Non-Small Cell Lung Cancer Study Group. J Clin Oncol , 2000, 18(12): 2354-2362.
17.	郭荣荣, 徐风华, 孙华燕. 多西紫杉醇作为晚期非小细胞肺癌的二线治疗药物的系统评价. 中国循证医学杂志, 2008, 8(10): 861-868.
18.	Calvert H, An overview of folate metabolism: features relevant to the action and toxicities of antifolate anticancer agents. Semin Oncol , 1999, 26(2 Suppl 6): 3-10.
19.	Adjei AA. Pharmacology and mechanism of action of pemetrexed. Clin lung cancer , 2004, 5 Suppl 2: S51-S55.
20.	Weiss GJ, Langer C, Rosell R, et al . Elderly Patients Bene?t From Second-Line Cytotoxic Chemotherapy: A Subset Analysis of a Randomized Phase III Trial of Pemetrexed Compared With Docetaxel in Patients With Previously Treated Advanced Non–Small-Cell Lung Cancer. J Clin Oncol , 2006, 24(27): 4405-4411.
21.	Asukai Y, Valladares A, Camps C, et al . Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population. BMC Cancer , 2010, 10: 26.

1. 2 Novello S, Le Chevaller T. Chemotherapy for non-small-cell lung cancer. Part 1: Early-stage disease. Oncology (Williston Park) , 2003, 17(3): 357-364.
2. National Cancer Institute SEER data. [2009-06-20]. Available at: http: //seer. cancer. gov/statistics/.
3. Socinski MA, Morris DE, Masters GA, et al . Chemotherapeutic Managenment of Stage Ⅳ Non-small Cell Lung Cancer. Chest , 2003, 123(1 Suppl): 226S-243S.
4. Di Maio M, Chiodini P, Georgoulias V, et al . Meta-analysis of single-agent chemotherapy compared with combination chemotherapy as second line treatment of advanced non-small-cell lung cancer. J Clin Oncol , 2009, 27(11): 1836-1843.
5. NCCN非小细胞肺癌临床实践指南专家组. 肿瘤学临床实践指南(中国版). 第1版. 2008: 20-21.
6. Ciuleanu T, Brodowicz T, Zielinski C, et al . Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet , 2009, 374(9699): 1432-1440.
7. 母连军. 培美曲塞获准作为非小细胞肺癌治疗的一线药. 国外医药抗生素分册, 2008, 29(6): 285-286.
8. 刘宝. 4种非小细胞肺癌二线药物治疗方案费用比较研究. 中国药房, 2010, 21(26): 2303-2406.
9. Higgins JPT, Altman DG. Assessing risk of bias in included studies. Cochrane Handbook for Systematic Review of Inerventions Version 5. 0. 0(update February 2008). The Cochrane Collaboration, 2008. Available from www. cochrane-handbook. org.
10. 陈墨, 周彩存, 张洁. 力比泰与泰素帝治疗非小细胞肺癌临床疗比较. 同济大学(医学版), 2008, 29(3): 54-57.
11. 胡广原, 梅齐, 熊慧华, 等. 培美曲塞二钠单药对比多西紫杉醇二线治疗晚期非小细胞肺癌临床观察. 临床荟萃, 2009, 24(13): 1166-1168.
12. 孟丽娟, 王峻, 刘福银, 等. 老年晚期非小细胞肺癌单药二线培美曲塞或多西他赛治疗的临床观察. 实用老年医学, 2010, 24(1): 66-68.
13. 冯永, 仲琴, 贾正飞, 等. 培美曲塞、多西紫杉醇治疗晚期非小细胞肺癌的疗效比较. 山东医药, 2010, 50(37): 53-54.
14. Hanna N, Shepherd FA, Fossella FV, et al . Randomized Phase Ⅲ Trial of Pemetrexed Versus Docetaxel in Patients With Non-Small-Cell Lung Cancer Previously Treated With Chemotherapy. J Clin Oncol , 2004, 22(9): 1589-1597.
15. Shepherd FA, Dancey J, Ramlau R, et al . prospective randomized trial of docetaxel versus best supportive care in patients with non-small cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol , 2000, 18(10): 2095-2103.
16. Fossella F, DeVore R, Kerr R, et al . Randomized phase Ⅲ trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small cell lung cancer previously treated with platinum-containing chemotherapy regimens The TAX 320 Non-Small Cell Lung Cancer Study Group. J Clin Oncol , 2000, 18(12): 2354-2362.
17. 郭荣荣, 徐风华, 孙华燕. 多西紫杉醇作为晚期非小细胞肺癌的二线治疗药物的系统评价. 中国循证医学杂志, 2008, 8(10): 861-868.
18. Calvert H, An overview of folate metabolism: features relevant to the action and toxicities of antifolate anticancer agents. Semin Oncol , 1999, 26(2 Suppl 6): 3-10.
19. Adjei AA. Pharmacology and mechanism of action of pemetrexed. Clin lung cancer , 2004, 5 Suppl 2: S51-S55.
20. Weiss GJ, Langer C, Rosell R, et al . Elderly Patients Bene?t From Second-Line Cytotoxic Chemotherapy: A Subset Analysis of a Randomized Phase III Trial of Pemetrexed Compared With Docetaxel in Patients With Previously Treated Advanced Non–Small-Cell Lung Cancer. J Clin Oncol , 2006, 24(27): 4405-4411.
21. Asukai Y, Valladares A, Camps C, et al . Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population. BMC Cancer , 2010, 10: 26.

《中国循证医学杂志》

培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的Meta分析

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《中国循证医学杂志》

培美曲塞与多西紫杉醇比较治疗晚期非小细胞肺癌的Meta分析

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