转移性非小细胞肺癌(NSCLC)提出了重大的临床挑战,促使对KRAS突变在预后和治疗反应中的作用进行重点研究。靶向治疗为干预提供了有希望的途径,对现有证据进行全面分析。2023年6月,我们的评论深入研究了MEDLINE(医学文献分析和在线检索系统),Embase,Scopus,和Cochrane受控试验登记册.严格的纳入和排除标准指导了12篇文章的选择,包括两项随机对照试验(RCT)和10项观察性研究。多名调查员独立执行数据提取,评估预后因素(总体和无进展生存期)和预测结果(治疗和客观反应)。纽卡斯尔-渥太华量表(NOS)和改良的Jadad评分用于观察性研究和随机对照试验的研究质量评估,分别。从最初的120篇文章中,选定的12项研究,2013年至2022年,包括2,845例转移性NSCLC患者。KRAS突变,特别是G12C变体,成为影响治疗反应的关键因素。值得注意的是,KRAS野生型患者对铂类化疗的反应增强,而具有KRAS突变的患者使用免疫检查点抑制剂(ICIs)表现出良好的结局。本系统综述强调了KRAS突变作为转移性NSCLC预后指标的作用。对生存和治疗反应都有影响。KRAS野生型和突变患者之间的区别提供了对定制治疗策略的见解。以铂类药物为基础的化疗和免疫检查点抑制剂成为上下文相关的选择。然而,需要更多的研究来巩固KRAS的预测作用,探索KRAS抑制剂和其他靶向疗法的疗效,为转移性NSCLC的精细化和个性化干预措施铺平了道路。
Metastatic non-small cell lung cancer (NSCLC) poses a significant clinical challenge, prompting a focused investigation into the role of KRAS mutations in prognosis and treatment response. Targeted therapies offer promising avenues for intervention, motivating a comprehensive analysis of existing evidence. Conducted in June 2023, our
review delved into MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Scopus, and the Cochrane Register of Controlled Trials. Rigorous inclusion and exclusion criteria guided the selection of 12 articles, comprising two randomized controlled trials (RCTs) and 10 observational studies. Multiple investigators independently executed data extraction, evaluating prognostic factors (overall and progression-free survival) and predictive outcomes (treatment and objective response). The Newcastle-Ottawa Scale (NOS) and modified Jadad scores were used for study quality assessment of observational studies and RCTs, respectively. From an initial pool of 120 articles, the 12 selected studies, spanning 2013 to 2022, encompassed 2,845 metastatic NSCLC patients. KRAS mutations, particularly the G12C variant, emerged as a pivotal factor influencing treatment response. Notably, KRAS wild type patients displayed enhanced responses to platinum-based chemotherapy, while those with KRAS mutations exhibited favourable outcomes with immune checkpoint inhibitors (ICIs). The role of KRAS mutations as prognostic indicators in metastatic NSCLC is underscored by this systematic
review, with implications for both survival and treatment response. The discernment between KRAS wild type and mutant patients offers insights into tailored therapeutic strategies, with platinum-based chemotherapy and immune checkpoint inhibitors emerging as context-dependent options. Nevertheless, more research is required to solidify the predictive role of KRAS and explore the efficacy of KRAS inhibitors and other targeted therapies, paving the way for refined and personalized interventions in the management of metastatic NSCLC.