PDF(Pubmed)
Abstract：
UNASSIGNED: Frequent failures observed in some trials comparing the efficacy and safety of osimertinib plus bevacizumab to osimertinib monotherapy in advanced non-small-cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) alterations have brought questions.
UNASSIGNED: To evaluate the efficacy and safety of these two treatment regimens in advanced NSCLC patients harboring EGFR mutations.
UNASSIGNED: This study is a systematic review and meta-analysis.
UNASSIGNED: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were extensively searched for relevant randomized controlled trials (RCTs) on 14 May 2023. Two researchers independently screened the literature, assessed quality, and extracted data. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The secondary outcomes were adverse events (AEs) and PFS stratified by patients\' characteristics. STATA 17.0 software (StataCorp LLC, USA) was adopted for meta-analysis.
UNASSIGNED: A total of four RCTs involving 390 patients were included. Overall, the risk of bias across the studies was moderate to low. Pooled results showed that compared to osimertinib alone, the addition of bevacizumab to osimertinib failed to show prolongation of PFS [hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.78-1.27], OS (HR = 1.01, 95% CI: 0.73-1.41), or improvement of the ORR (risk ratio = 1.12, 95% CI: 0.90-1.38), while an increased incidence of some AEs was observed, such as nausea, oral mucositis, hypertension, and proteinuria. Notably, combination treatment did significantly prolong the PFS in the subset of smokers (HR = 0.64, 95% CI: 0.44-0.94). A mild trend toward PFS benefit under the combined regimen was also noted in patients with brain metastases and first-line treatment, though not reaching statistical significance.
UNASSIGNED: Based on the available evidence, the addition of bevacizumab to osimertinib could not provide additional survival benefits with higher but manageable toxicity for EGFR-mutant NSCLC patients. Osimertinib monotherapy remains the prioritized treatment. Further investigation is warranted.
UNASSIGNED: To evaluate the efficacy and safety of these two treatment regimens in advanced NSCLC patients harboring EGFR mutations.
UNASSIGNED: This study is a systematic review and meta-analysis.
UNASSIGNED: PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were extensively searched for relevant randomized controlled trials (RCTs) on 14 May 2023. Two researchers independently screened the literature, assessed quality, and extracted data. The primary outcomes were progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The secondary outcomes were adverse events (AEs) and PFS stratified by patients\' characteristics. STATA 17.0 software (StataCorp LLC, USA) was adopted for meta-analysis.
UNASSIGNED: A total of four RCTs involving 390 patients were included. Overall, the risk of bias across the studies was moderate to low. Pooled results showed that compared to osimertinib alone, the addition of bevacizumab to osimertinib failed to show prolongation of PFS [hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.78-1.27], OS (HR = 1.01, 95% CI: 0.73-1.41), or improvement of the ORR (risk ratio = 1.12, 95% CI: 0.90-1.38), while an increased incidence of some AEs was observed, such as nausea, oral mucositis, hypertension, and proteinuria. Notably, combination treatment did significantly prolong the PFS in the subset of smokers (HR = 0.64, 95% CI: 0.44-0.94). A mild trend toward PFS benefit under the combined regimen was also noted in patients with brain metastases and first-line treatment, though not reaching statistical significance.
UNASSIGNED: Based on the available evidence, the addition of bevacizumab to osimertinib could not provide additional survival benefits with higher but manageable toxicity for EGFR-mutant NSCLC patients. Osimertinib monotherapy remains the prioritized treatment. Further investigation is warranted.
摘要：
■在一些比较奥希替尼联合贝伐单抗与奥希替尼单药治疗晚期非小细胞肺癌（NSCLC）表皮生长因子受体（EGFR）改变的疗效和安全性的试验中，经常观察到的失败带来了疑问。
■评估这两种治疗方案在EGFR突变的晚期NSCLC患者中的疗效和安全性。
■本研究是一项系统综述和荟萃分析。
■PubMed,Embase,科克伦图书馆,WebofScience,CNKI,万方,和VIP数据库在2023年5月14日广泛搜索相关随机对照试验(RCT).两名研究人员独立筛选了文献，评估质量，并提取数据。主要结果是无进展生存期（PFS），总生存期（OS），和客观反应率（ORR）。次要结局为不良事件（AEs）和PFS，按患者特征进行分层。STATA17.0软件(StataCorpLLC,采用美国）进行荟萃分析。
■共纳入4个RCT，涉及390名患者。总的来说,所有研究的偏倚风险为中等至较低.汇总结果显示，与单独使用奥希替尼相比，奥希替尼加用贝伐单抗未能显示PFS延长[风险比(HR)=1.00,95%置信区间(CI):0.78-1.27],OS（HR=1.01，95%CI：0.73-1.41），或ORR的改善(风险比=1.12，95%CI：0.90-1.38)，虽然观察到一些AE的发生率增加，比如恶心，口腔粘膜炎，高血压,和蛋白尿。值得注意的是,联合治疗确实显著延长了吸烟者亚组的PFS(HR=0.64,95%CI:0.44~0.94).在脑转移和一线治疗的患者中，联合治疗方案下的PFS获益也有轻微趋势。虽然没有达到统计意义。
■根据现有证据，对于EGFR突变型NSCLC患者,在奥希替尼基础上加用贝伐单抗不能带来额外的生存获益,但毒性较高,但可控制.奥希替尼单一疗法仍然是优先治疗。需要进一步调查。
■评估这两种治疗方案在EGFR突变的晚期NSCLC患者中的疗效和安全性。
■本研究是一项系统综述和荟萃分析。
■PubMed,Embase,科克伦图书馆,WebofScience,CNKI,万方,和VIP数据库在2023年5月14日广泛搜索相关随机对照试验(RCT).两名研究人员独立筛选了文献，评估质量，并提取数据。主要结果是无进展生存期（PFS），总生存期（OS），和客观反应率（ORR）。次要结局为不良事件（AEs）和PFS，按患者特征进行分层。STATA17.0软件(StataCorpLLC,采用美国）进行荟萃分析。
■共纳入4个RCT，涉及390名患者。总的来说,所有研究的偏倚风险为中等至较低.汇总结果显示，与单独使用奥希替尼相比，奥希替尼加用贝伐单抗未能显示PFS延长[风险比(HR)=1.00,95%置信区间(CI):0.78-1.27],OS（HR=1.01，95%CI：0.73-1.41），或ORR的改善(风险比=1.12，95%CI：0.90-1.38)，虽然观察到一些AE的发生率增加，比如恶心，口腔粘膜炎，高血压,和蛋白尿。值得注意的是,联合治疗确实显著延长了吸烟者亚组的PFS(HR=0.64,95%CI:0.44~0.94).在脑转移和一线治疗的患者中，联合治疗方案下的PFS获益也有轻微趋势。虽然没有达到统计意义。
■根据现有证据，对于EGFR突变型NSCLC患者,在奥希替尼基础上加用贝伐单抗不能带来额外的生存获益,但毒性较高,但可控制.奥希替尼单一疗法仍然是优先治疗。需要进一步调查。
