背景:玻璃体视网膜淋巴瘤(VRL)通常用眼内甲氨蝶呤(ioMTX)联合治疗,大剂量静脉注射甲氨蝶呤(HD-MTX),或局部放疗(RT)作为第一选择。单一疗法如布鲁顿酪氨酸激酶抑制剂(BTKi)对PVRL的有效性和安全性仍不确定。
方法:通过搜索PubMed,对一线联合治疗或单药治疗的VRL患者的临床试验数据和会议摘要进行系统评价和荟萃分析,Embase,和Scopus数据库,直到2022年12月。共纳入24项研究,包括517名患者,和生存数据从279例患者中提取,因为不同研究的单位不一致。
结果:联合治疗组使用ioMTX+化疗(4项研究),RT+化疗(2项研究),基于ioMTX/HD-MTX的方案(在2项研究中),ioMTX+RT+化疗(2项研究),ioMTX+来那度胺/BTKi(2项研究)和多种疗法的组合(7项研究)。单一疗法组主要用口服单一疗法如BTKi治疗。联合治疗的总反应率(ORR)和完全缓解率(CRR)高于单药治疗(ORR:96%vs.72%,CRR:92%与63%)。联合治疗还可以延长中位无进展生存期(28.8个月vs.13个月,p=0.012)。然而,联合治疗组比单一治疗组有更严重的副作用(3/4级毒性)(45%vs.8%)。
结论:研究显示联合治疗有较好的OR和CR率,更长的生存时间,毒性比单一疗法更大。虽然BTK抑制剂耐受性良好,长期有效性需要前瞻性研究的确认。此外,鉴于VRL单一疗法的研究数量较少,需要更多的研究来验证其效果。
背景:CRD42023400305.
BACKGROUND: Vitreoretinal lymphoma (VRL) is usually treated with a combination of intraocular methotrexate (ioMTX), high-dose intravenous methotrexate (HD-MTX), or local radiotherapy (RT) as the first options. The effectiveness and safety of monotherapy like bruton\'s tyrosine kinase inhibitors (BTKi) for PVRL remain uncertain.
METHODS: A systematic review and meta-analysis of clinical trial data and conference abstracts in VRL patients treated with first-line combination therapy or monotherapy were conducted through a search of PubMed, Embase, and Scopus databases until December 2022. A total of 24 studies comprising 517 patients were included, and survival data were extracted from 279 patients due to inconsistent units across studies.
RESULTS: The combined treatment group used ioMTX + chemotherapy (in 4 studies), RT + chemotherapy (in 2 studies), ioMTX/HD-MTX based regimen (in 2 studies), ioMTX + RT + chemotherapy (in 2 studies), ioMTX + lenalidomide/BTKi (in 2 studies) and combination of multiple therapies (in 7 studies). The monotherapy group was mainly treated with oral monotherapies such as BTKi. The combination therapy had a higher overall response rate (ORR) and complete response rate (CRR) than monotherapy (ORR: 96% vs. 72%, CRR: 92% vs. 63%). Combination therapy also resulted in a longer median progression-free survival (28.8 months vs. 13 months, p = 0.012). However, the combination therapy group had more severe side effects (grade 3/4 toxicity) than the monotherapy group (45% vs. 8%).
CONCLUSIONS: The study showed combination therapy had better OR and CR rates, longer survival, and more toxicity than monotherapy. While BTK inhibitors were well-tolerated, long-term effectiveness needs confirmation from prospective studies. In addition, given the small number of studies of monotherapy for VRL, more studies are needed to validate its effects.
BACKGROUND: CRD42023400305.