晚期肝细胞癌的二线治疗：随机对照试验的系统评价和网络

StephenW

J Clin Gastroenterol. 2018 Dec 19. doi: 10.1097/MCG.0000000000001160. [Epub ahead of print]
Second-line Treatments of Advanced Hepatocellular Carcinoma: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
Bakouny Z1, Assi T, El Rassy E, Nasr F.
Author information
Abstract
BACKGROUND:

Advanced hepatocellular carcinoma (HCC) constitutes the second leading cause of cancer-related deaths. First-line therapy is either sorafenib or lenvatinib. Several treatment options have been recently added to the second-line treatment of advanced HCC. The aim of this network meta-analysis of randomized controlled trials was to compare the second-line treatments of advanced HCC.
METHODS:

Network meta-analyses were computed for overall survival (OS), progression-free survival, rates of grade 3 to 5 adverse events, and for treatment discontinuation due to adverse events. OS was considered to be the primary outcome of this study, and everolimus was chosen to be the common comparator for efficacy analyses and placebo for safety analyses. Subgroup analyses were computed for OS in patients with hepatitis B, patients with hepatitis C, Asian patients, patients with macrovascular invasion, and patients with extrahepatic metastases.
RESULTS:

Thirteen randomized controlled trials including 5076 patients and evaluating 11 agents were found to be eligible. Regorafenib [hazard ratio (HR)=0.60, 95% confidence interval (CI)=0.44-0.81] and cabozantinib (HR=0.72, 95% CI=0.55-0.95) were found to significantly prolong OS compared with everolimus. The effect of regorafenib on OS tended to be conserved across patient subgroups. Regorafenib was also found to significantly prolong progression-free survival (HR=0.46, 95% CI=0.35-0.62) and significantly increase the rates of grade 3 to 5 adverse events (odds ratios=3.18, 95% CI=2.22-4.54) and treatment discontinuation due to adverse events (odds ratios=2.67, 95% CI=1.21-5.87).
CONCLUSIONS:

This network meta-analysis concludes that, based on current evidence, regorafenib could be the agent of choice in the second-line treatment of HCC, with cabozantinib as a possible alternative for sorafenib-intolerant patients.

PMID:
    30575632
DOI:
    10.1097/MCG.0000000000001160

StephenW

J Clin Gastroenterol。 2018年12月19日doi：10.1097 / MCG.0000000000001160。 [提前打印]
晚期肝细胞癌的二线治疗：随机对照试验的系统评价和网络荟萃分析。
Bakouny Z1，Assi T，El Rassy E，Nasr F.
作者信息
抽象
背景：

晚期肝细胞癌（HCC）是癌症相关死亡的第二大原因。一线治疗是索拉非尼或lenvatinib。最近在晚期HCC的二线治疗中增加了几种治疗方案。这项网络荟萃分析随机对照试验的目的是比较晚期HCC的二线治疗。
方法：

计算总生存期（OS），无进展生存期，3至5级不良事件发生率以及因不良事件导致的治疗中断的网络荟萃分析。 OS被认为是本研究的主要结果，依维莫司被选为功效分析和安慰剂用于安全性分析的常用比较物。对乙型肝炎患者，丙型肝炎患者，亚洲患者，大血管侵犯患者和肝外转移患者的OS计算亚组分析。
结果：

发现包括5076名患者和评估11名药物在内的13项随机对照试验符合条件。与依维莫司相比，Regorafenib [风险比（HR）= 0.60,95％置信区间（CI）= 0.44-0.81]和cabo​​zantinib（HR = 0.72,95％CI = 0.55-0.95）被发现显着延长OS。瑞格非尼对OS的影响倾向于在患者亚组中保守。 Regorafenib也被发现显着延长无进展生存期（HR = 0.46,95％CI = 0.35-0.62）并且显着增加3至5级不良事件的发生率（优势比= 3.18,95％CI = 2.22-4.54）由于不良事件导致治疗中止（优势比= 2.67,95％CI = 1.21-5.87）。
结论：

该网络荟萃分析得出结论，根据目前的证据，瑞格非尼可能是HCC二线治疗的首选药物，卡博替尼可能是索拉非尼不耐受患者的替代药物。

结论：
    30575632
DOI：
    10.1097 / MCG.0000000000001160