目前,治疗铂耐药复发性卵巢癌的最佳治疗方法仍有待充分阐明.本系统综述和网络荟萃分析旨在阐明阿帕替尼的相对疗效和安全性。作为单一疗法或与化疗联合使用,与单纯化疗相比,用于治疗铂耐药的复发性卵巢癌。PubMed,检索了Embase和万方数据电子数据库,搜索从数据库的概念到2023年4月。进行质量评估,并使用R软件进行网络荟萃分析。纳入和排除标准筛选后,本分析包括17项临床试验,合并1,228例铂类耐药复发性卵巢癌患者的数据,分为以下3个治疗组:i)555例接受阿帕替尼联合化疗的患者;ii)229例接受阿帕替尼单独治疗的患者;iii)444例接受常规化疗的患者.本研究的结果表明,阿帕替尼与tegiol[比值比(OR),2.54;95%CI,1.06-6.11]或依托泊苷(OR,2.12;95%CI,1.20-3.74)与阿帕替尼单药治疗后相比,显着提高了客观缓解率(ORR)。相比之下,与阿帕替尼治疗相比,吉西他滨单药治疗导致ORR疗效较差(OR,0.47;95%CI,0.23-0.95)。此外,阿帕替尼与依托泊苷的组合(OR,1.32;95%CI,1.06-1.64)或紫杉醇(OR,1.52;95%CI,1.04-2.23)与单独使用阿帕替尼相比,疾病控制率(DCR)显着提高。根据累计排名分析下的面积,就DCR而言,阿帕替尼和紫杉醇联合使用是最有效的治疗方式.在安全方面,不良事件的发生率,例如手足综合征[相对风险(RR),4.23;95%CI,1.80-9.95]和高血压(RR,4.80;95%CI,1.53-15.05),发现在接受含阿帕替尼治疗的患者中,与单纯化疗相比。因此,本荟萃分析强调了阿帕替尼的潜力,特别是联合化疗,作为铂耐药复发性卵巢癌患者的治疗策略。
At present, the optimal therapeutic approach for the treatment of platinum-resistant recurrent ovarian cancer remains to be fully elucidated. The present systematic review and network meta-analysis aimed to elucidate the relative efficacy and safety of
apatinib, administered either as monotherapy or in conjunction with chemotherapy, compared with chemotherapy alone, for the treatment of platinum-resistant recurrent ovarian cancer. The PubMed, Embase and Wanfang Data electronic databases were searched, where the search spanned from the conception of the databases until April 2023. A quality evaluation was conducted and R software was used for network meta-analysis. Following inclusion and exclusion criteria screening, the present analysis included 17 clinical trials, combining data from 1,228 patients with platinum-resistant recurrent ovarian cancer categorized into the following three treatment cohorts: i) 555 patients who received apatinib plus chemotherapy; ii) 229 patients who received
apatinib alone; and iii) 444 patients who underwent conventional chemotherapy. Results of the present study demonstrated that the co-administration of
apatinib with either tegiol [odds ratio (OR), 2.54; 95% CI, 1.06-6.11] or etoposide (OR, 2.12; 95% CI, 1.20-3.74) significantly improved the objective response rate (ORR) compared with that following apatinib monotherapy. By contrast, gemcitabine monotherapy resulted in inferior ORR efficacy compared with that following apatinib (OR, 0.47; 95% CI, 0.23-0.95). In addition, combinations of
apatinib with etoposide (OR, 1.32; 95% CI, 1.06-1.64) or paclitaxel (OR, 1.52; 95% CI, 1.04-2.23) demonstrated a significantly improved disease control rates (DCR) compared with those following apatinib alone. According to the area under the cumulative ranking analysis,
apatinib and paclitaxel in combination was the most efficacious treatment modality in terms of DCR. In terms of safety, the incidence of adverse events, such as hand-foot syndrome [relative risk (RR), 4.23; 95% CI, 1.80-9.95] and hypertension (RR, 4.80; 95% CI, 1.53-15.05), was found to be significantly higher in patients treated with apatinib-containing therapies, compared with those treated with chemotherapy alone. Consequently, the present meta-analysis highlighted the potential of apatinib, particularly in combination with chemotherapy, as a therapeutic strategy for patients with platinum-resistant recurrent ovarian cancer.