目的:通过网络meta分析评价转移性结直肠癌一线全身治疗的安全性。
方法:来自PubMed的文献,Embase,WebofScience,从数据库建立到2023年8月15日,我们搜索了CochraneLibrary数据库,并对筛选研究应用了严格的纳入和排除标准.使用Cochrane偏差风险评估工具(RoB2.0)评估纳入文献的质量。采用Stata15.0和R4.3.1软件进行网络meta分析,比较不同治疗方案的不良事件发生率。
结果:共有53项随机对照试验,涉及17,351例转移性结直肠癌(mCRC)患者,最终包括在内,包括29种不同的治疗方法。根据SUCRA排名,CAPOX方案最有可能在安全性方面排名第一,而FOLFOXIRI+帕尼单抗方案最有可能排在最后。就具体的AE而言,CAPOX方案,无论是单独使用还是与靶向药物(贝伐单抗和西妥昔单抗)联合使用,与中性粒细胞减少症和发热性中性粒细胞减少症的风险降低有关,以及血小板减少症和腹泻的风险增加。FOLFOX方案,有或没有贝伐单抗,与中性粒细胞减少症和周围感觉神经病变的风险增加有关。FOLFIRI/CAPIRI+贝伐单抗方案与外周感觉神经病变风险降低相关。S-1和S-1+奥沙利铂在胃肠道反应方面耐受性良好。FOLFOXIRI方案,无论是单独使用还是与靶向药物联合使用,与各种AE相关。
结论:总之,CAPOX方案可能是mCRC患者一线全身治疗方案中最安全的选择,而FOLFOXIRI+帕尼单抗方案可能与更高的3级或更高的AE发生率相关.
OBJECTIVE: To evaluate the safety of first-line systemic therapy for metastatic colorectal cancer through network meta-analysis.
METHODS: The literature from PubMed, Embase, Web of Science, and Cochrane Library databases was searched from the inception of the databases to August 15, 2023, and strict inclusion and exclusion criteria were applied to screen studies. The Cochrane Bias Risk Assessment Tool (RoB 2.0) was used to evaluate the quality of the included literature. Network meta-analysis was conducted using Stata 15.0 and R4.3.1 software to compare the incidence of adverse events (AEs) among different treatment regimens.
RESULTS: A total of 53 randomized controlled trials, involving 17,351 patients with metastatic colorectal cancer (mCRC), were ultimately included, encompassing 29 different therapeutic approaches. According to SUCRA rankings, the CAPOX regimen is most likely to rank first in terms of safety, while the FOLFOXIRI + panitumumab regimen is most likely to rank last. In terms of specific AEs, the CAPOX regimen, whether used alone or in combination with targeted drugs (bevacizumab and cetuximab), is associated with a reduced risk of neutropenia and febrile neutropenia, as well as an increased risk of thrombocytopenia and diarrhea. The FOLFOX regimen, with or without bevacizumab, is linked to an increased risk of neutropenia and peripheral sensory neuropathy. The FOLFIRI/CAPIRI + bevacizumab regimen is associated with a reduced risk of peripheral sensory neuropathy. S-1 and S-1 + oxaliplatin are well-tolerated in terms of gastrointestinal reactions. The FOLFOXIRI regimen, whether used alone or in combination with targeted drugs, is associated with various AEs.
CONCLUSIONS: In summary, the CAPOX regimen may be the safest option among the first-line systemic treatment regimens for mCRC patients, while the FOLFOXIRI + panitumumab regimen may be associated with a higher incidence of grade 3 or higher AEs.