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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (7): 74-82.doi: 10.6040/j.issn.1671-7554.0.2022.0238

• 临床医学 • 上一篇    下一篇

晚期驱动基因阴性、PD-L1表达阴性非鳞非小细胞肺癌一线治疗方案的网状Meta分析

秦静,杨飞,陈谦,夏涵岱,刘延国,王秀问   

  1. 山东大学齐鲁医院化疗科, 山东 济南 250012
  • 发布日期:2022-07-27
  • 通讯作者: 王秀问. E-mail:xiuwenwang12@ sdu.edu.cn 刘延国. E-mail:liuyanguo@sdu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(81874044);山东省自然科学基金面上项目(ZR2020MH236,ZR2019MH050);北京市希思科临床肿瘤学研究基金(Y-QL2019-0376)

A network meta-analysis of first-line treatment options for patients with advanced driver-gene wild-type and PD-L1 negative non-squamous non-small cell lung cancer

QIN Jing, YANG Fei, CHEN Qian, XIA Handai, LIU Yanguo, WANG Xiuwen   

  1. Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2022-07-27

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摘要： 目的 对晚期驱动基因阴性、程序性死亡配体1(PD-L1)表达阴性非鳞非小细胞肺癌(NSCLC)一线治疗方案疗效和安全性进行网状Meta分析。 方法 检索PubMed、Cochrane Library、Embase数据库及ClinicalTrials.gov网站有关晚期驱动基因阴性非鳞NSCLC一线治疗研究,纳入包括化疗、免疫检查点抑制剂(ICIs)、抗血管生成药物及其联合治疗的随机对照试验(RCT),使用StataMP 16. 0及R 4.1.0软件进行网状Meta分析。 结果 共纳入10个RCT、5731例非鳞NSCLC患者,涉及10种治疗方案。各治疗方案总生存期(OS)和无进展生存期(PFS)差异无统计学意义(P均>0.05)。OS概率排序居第1位的是帕博利珠单抗联合化疗,PFS概率排序居第1位的是纳武利尤单抗联合贝伐珠单抗及化疗。在有效率方面,阿替利珠单抗联合化疗、帕博利珠单抗联合化疗的客观缓解率(ORR)高于化疗(OR=1.66,95%CI:1.07~2.59;OR=2.68,95%CI:1.40~5.11)。在所有级别不良反应率方面,卡瑞利珠单抗联合化疗的不良反应率高于化疗及信迪利单抗联合化疗(OR=1.05,95%CI:1.01~1.08;OR=1.05,95%CI:1.01~1.09)。在≥3级不良反应率方面,各治疗方案差异无统计学意义(P均>0.05)。 结论 对于PD-L1表达阴性的晚期驱动基因阴性非鳞NSCLC患者,现有的一线治疗方案在生存获益上未见明显差异。免疫联合化疗有效率更高、但不良反应也更为显著,需根据患者个体状况选择合理的治疗方案。

关键词: 非小细胞肺癌, 网状Meta分析, 程序性死亡配体1, 化疗, 抗血管生成治疗, 免疫治疗

Abstract: Objective A network meta-analysis was performed to compare the efficacy and safety of first-line treatment regimens of advanced driver-gene wild-type and programmed death-ligand 1(PD-L1)negative non-squamous non-small cell lung cancer(NSCLC). Methods First-line treatment trials of advanced driver-gene wild-type non-squamous NSCLC were searched in PubMed, Cochrane Library, Embase database and ClinicalTrials.gov website. Randomized controlled trials(RCTs)comparing first-line treatment regimens including chemotherapy, immune checkpoint inhibitors(ICIs), antiangiogenic therapy and their combinations were included. StataMP 16.0 and R 4.1.0 were used for data analysis. Results A total of 10 RCTs were included, involving 5,731 patients and 10 treatment regimens. There was no statistically significant difference in overall survival(OS)and progression-free survival(PFS)among the treatment regimens(P>0.05). The regimen of pembrolizumab + chemotherapy had the longest OS, and the regimen of nivolumab+bevacizumab+chemotherapy had the longest PFS. The objective response rates(ORR)of atezolizumab+ chemotherapy and pembrolizumab+chemotherapy were higher than that of chemotherapy(OR=1.66, 95%CI: 1.07-2.59; OR=2.68, 95%CI: 1.40-5.11). In terms of allgrade adverse events(AEs), camrelizumab + chemotherapy was higher(AEs)than chemotherapy and sintilimab + chemotherapy(OR=1.05, 95%CI: 1.01-1.08; OR=1.05, 95%CI: 1.01-1.09). In terms of ≥3 grade AEs, there was no statistically significant difference among the treatment regimens(P>0.05). Conclusion For patients with advanced driver-gene wild-type PD-L1 negative non-squamous NSCLC, there was no significant difference in survival benefits among the existing first-line treatment regimens. The combination of immunotherapy and chemotherapy was more effective, but the adverse events were also more significant. A reasonable treatment regimen should be selected according to the individual conditions.

Key words: Non-small cell lung cancer, Network meta-analysis, Programmed death-ligand 1, Chemotherapy, Antiangiogenic therapy, Immunotherapy

中图分类号: 

  • R734.2
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