■表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)联合全脑放疗(WBRT)治疗非小细胞肺癌患者脑转移的疗效和安全性尚待确定。
■使用包括PubMed,Embase,WebofScience,科克伦,万方,和中国国家知识基础设施(CNKI),目的探讨EGFR-TKI联合WBRT治疗非小细胞肺癌脑转移的相关临床研究。采用Stata17.0软件进行统计分析,涵盖直到2023年3月1日发表的临床研究。
■该分析纳入了23项随机对照试验(RCT),共涉及2,025名患者。其中,1,011人被分配到同时接受EGFR-TKI和WBRT的组,而1,014人被分配到WBRT单独组。结果表明,EGFR-TKI和WBRT的组合显着提高了颅内客观缓解率(RR=1.57,95%CI:1.42-1.74,p<0.001),提高颅内疾病控制率(RR=1.30,95%CI:1.23-1.37,p<0.001),并提高1年生存率(RR=1.48,95%CI:1.26-1.73,p<0.001)。此外,这种联合治疗与显著的生存优势(RR=1.48,95%CI:1.26-1.73,p<0.001)和不良反应发生率降低(RR=0.65,95%CI:0.51-0.83,p<0.001)相关,尤其是恶心和呕吐(RR=0.54,95%CI:0.37-0.81,p=0.002)和骨髓抑制(RR=0.59,95%CI:0.40-0.87,p=0.008).然而,无统计学差异观察到腹泻(RR=1.15,95%CI:0.82-1.62,p=0.418),皮疹(RR=1.35,95%CI:0.88-2.07,p=0.164)。
■与单独的WBRT相比,EGFR-TKI和WBRT的组合显著改善颅内反应,提高客观反应率,疾病控制率,非小细胞肺癌脑转移患者的1年生存率。此外,除了轻微的皮疹和腹泻,其他不良反应的发生率无统计学显著增加.根据收集到的全面证据,第三代EGFR-TKI联合WBRT被推荐作为NSCLC脑转移患者的首选治疗方案,为转移性脑病变提供卓越的管理。
■https://www.crd.约克。AC.uk/PROSPERO/#,CRD42023415566。
UNASSIGNED: The efficacy and safety of combining epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) with whole-brain radiotherapy (WBRT) for treating brain metastases in non-small cell lung cancer patients remains to be determined.
UNASSIGNED: A systematic search was conducted using databases including PubMed, Embase, Web of Science, Cochrane, Wanfang, and China National Knowledge Infrastructure (CNKI), aiming to identify relevant clinical studies on the treatment of brain metastases originating from non-small cell lung cancer through the combination of EGFR-TKI and WBRT. Statistical analysis was performed utilizing Stata 17.0 software, covering clinical studies published until March 1, 2023.
UNASSIGNED: This analysis incorporated 23 randomized controlled trials (RCTs), involving a total of 2,025 patients. Of these, 1,011 were allocated to the group receiving both EGFR-TKI and WBRT, while 1,014 were assigned to the WBRT alone group. The findings reveal that the combination of EGFR-TKI and WBRT significantly improves the intracranial objective remission rate (RR = 1.57, 95% CI: 1.42-1.74, p < 0.001), increases the intracranial disease control rate (RR = 1.30, 95% CI: 1.23-1.37, p < 0.001), and enhances the 1-year survival rate (RR = 1.48, 95% CI: 1.26-1.73, p < 0.001). Additionally, this combined treatment was associated with a significant survival advantage (RR = 1.48, 95% CI: 1.26-1.73, p < 0.001) and a reduced incidence of adverse effects (RR = 0.65, 95% CI: 0.51-0.83, p < 0.001), particularly with respect to nausea and vomiting (RR = 0.54, 95% CI: 0.37-0.81, p = 0.002) and myelosuppression (RR = 0.59, 95% CI: 0.40-0.87, p = 0.008). However, no statistically significant differences were observed for diarrhea (RR = 1.15, 95% CI: 0.82-1.62, p = 0.418), and skin rash (RR = 1.35, 95% CI: 0.88-2.07, p = 0.164).
UNASSIGNED: In contrast to WBRT alone, the combination of EGFR-TKI and WBRT significantly improves intracranial response, enhancing the objective response rate, disease control rate, and 1-year survival rate in NSCLC patients with brain metastases. Moreover, aside from mild cases of rash and diarrhea, there is no statistically significant increase in the incidence of additional adverse effects. Based on the comprehensive evidence collected, the use of third-generation EGFR-TKI combined with WBRT is recommended as the preferred treatment for NSCLC patients with brain metastases, offering superior management of metastatic brain lesions.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO/#, CRD42023415566.