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JCO：Tax-PF诱导化疗治疗局部晚期头颈癌结局较好

2013-07-25 JCO dxy

头颈癌Tax-PFJCO随机试验
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部分针对局部晚期头颈癌(LAHNC)进行的随机试验曾对顺铂-氟尿嘧啶(PF)诱导化疗方案与紫杉类(多西他赛或紫杉醇)、顺铂及氟尿嘧啶(Tax-PF)方案进行过比较。在2013年7月8日在线出版的《临床肿瘤学杂志》(Journal of Clinical Oncology)上，法国古斯塔夫·鲁西研究所Jean-Pierre Pignon博士等人对相关研究进行了一项荟萃分析，该分析对Tax-PF与PF

部分针对局部晚期头颈癌(LAHNC)进行的随机试验曾对顺铂-氟尿嘧啶(PF)诱导化疗方案与紫杉类(多西他赛或紫杉醇)、顺铂及氟尿嘧啶(Tax-PF)方案进行过比较。在2013年7月8日在线出版的《临床肿瘤学杂志》(Journal of Clinical Oncology)上，法国古斯塔夫·鲁西研究所Jean-Pierre Pignon博士等人对相关研究进行了一项荟萃分析，该分析对Tax-PF与PF方案的药效与毒性进行了考察，并对不同患者亚群的结局差异进行了鉴定。

该分析共甄别出5项随机试验中的1,772例患者。同时对所有试验中的患者最新数据(IPD)进行了检索。按试验进行分层后，利用对数秩检验法进行比较。此外，通过互作效应或趋势检验对协变量及治疗间的相互作用进行研究。

结果显示，相关研究的中位随访时间为4.9年。患者死亡风险比(HR)为0.79 ，Tax-PF结果较好。异质性较为显著，并与一项试验有关。将该试验筛除后，不再存在异质性，最终死亡HR为0.72 ，Tax-PF结果较好。治疗效果与以下患者协变量间并无互作效应：年龄、性别、功能状态、肿瘤分期或部位。Tax-PF与进展程度、局部失败及远端失败的明显降低间存在显著关联，HR分别为0.78 、0.79 及 0.63 。

该项IPD荟萃分析表明，Tax-PF诱导化疗方案优于PF方案。但该方案在LSHNC控制中的准确作用仍需进一步确定。

背景介绍：尽管筛查手段已经取得了部分进展，同时流行病学趋势也出现了变化，但在确诊时，头颈部鳞状细胞癌(HNSCC)患者仍多处于局部晚期阶段。作为一种常规治疗手段，现已证明同步放化疗(CRT)可改善患者生存。针对头颈癌化疗(MACH-NC)的荟萃研究显示，通过顺铂-氟尿嘧啶(PF)诱导化疗进行的局部治疗并未降低局部失败率。不仅如此，该方案与较小的总生存率及远端失败率改善有关。MACH-NC数据库中，一项生存率探索性间接分析表明，CRT优于PF诱导化疗。因此除了保喉治疗外(PF诱导化疗和同步CRT均可作为常规治疗手段)，并不将PF作为局部晚期HNSCC的常规治疗手段。

在近期的随机试验中，曾针对紫杉类、顺铂及氟尿嘧啶(Tax-PF)诱导治疗方案是否优于PF方案进行了研究。多少研究证明，Tax-PF组患者OS及无进展生存率(PFS)均取得显著增加，但因研究能力所限，未能针对更具体终点展开研究。

因此，MACH-NC协作组于2008年启动了包括所有紫杉类药物临床试验在内的MACH-NC数据库更新，从中可对生存、失败类型、毒性及治疗效果与患者亚群间的互作效应等终点的相关结果进行归纳。


Blanchard P, Bourhis J, Lacas B, Posner MR, Vermorken JB, Cruz Hernandez JJ, Bourredjem A, Calais G, Paccagnella A, Hitt R, Pignon JP;Taxane-Cisplatin-Fluorouracil As Induction Chemotherapy in Locally Advanced Head and Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group.J Clin Oncol. 2013 Jul 8.

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    2014-06-19 lidong40

    #JCO#

    0

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    2014-06-15 yhy100208

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    2013-07-27 DEXTER3139

    #头颈癌#

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    2013-07-27 chg122

    #局部#

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    2013-07-27 xinxin088

    #诱导化疗#

    0

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