加载中........
×

cancer:NSCLC治疗,卡铂该选择与谁联合?

2013-4-18 作者:cancer   来源:医脉通 我要评论0
Tags: 肺癌  lung  cancer  卡铂  紫杉醇  

最近,美国Dana-Farber癌症研究中心公布了一份研究报告。报告利用现有的病例数据,比较了从2000年到2007年间卡铂+紫杉醇、卡铂+吉西他滨、卡铂+多西他赛对于非小细胞肺癌(NSCLC)患者的治疗效果。研究结果表明,对于非小细胞肺癌患者,卡铂+紫杉醇的治疗效果稍微优于其它两组。该研究的论文发表在:Cancer. 2013 Apr 5.
       之前进行的随机临床试验说明,在非小细胞肺癌的治疗中不同含铂药物的组合可以产生相同的疗效。基于组织病理学诊断的鳞状细胞癌和非鳞状细胞癌的结果,这些不同含铂药物的组合方案的相对疗效和可比性还无法确定。
       在该研究中,研究人员使用了SEER(监督、流行病学和最终结果)-医疗保险关联数据,搜集了2000年至2007年诊断为 IIIB期/IV期的NSCLC的享有医疗保险的患者的资料,用来比较对他们进行治疗的一线化疗药物。研究人员对接受了三种最常见的治疗方案的患者总生存期进行了对比,这些患者接受的化疗方案分别是:卡铂+紫杉醇、卡铂+吉西他滨、卡铂+多西他赛。对于组织病理学诊断的鳞状细胞癌和非鳞状细胞癌的患者,研究人员对他们的治疗结果进行了分层分析。研究中采用的多变量Cox比例风险模型和倾向评分分析有助于调整病人特征间的失衡。
       在15,318 名接受一线化疗的病人中,43.1%的病人接受了卡铂+紫杉醇的治疗,14.3%的病人接受了卡铂+吉西他滨的治疗、8.5%的病人接受了卡铂+多西他赛的治疗,还有34.1%的病人接受了其它化疗方案。
       研究结果发现,卡铂+紫杉醇一组的病人中位生存期为8.0个月(四分位距[IQR], 3.5-17.4个月);卡铂+吉西他滨一组的病人中位生存期为7.3个月(IQR, 3.4-15.2个月);卡铂+多西他赛一组的病人中位生存期为7.5个月(IQR, 3.2-16.0个月)。多变量Cox模型和倾向分数调整的Cox模型均表明,卡铂+紫杉醇的治疗效果稍优于卡铂+吉西他滨或卡铂+多西他赛的治疗效果。在倾向评分-分层模型中,前者的风险比为1.09(95%CI, 1.02-1.16),后两者的风险比为1.10(95%CI, 1.04-1.05)。在2,063名鳞状细胞癌患者的亚组中,倾向评分-分层分析显示,卡铂+吉西他滨一组的病人比卡铂+紫杉醇一组的病人有更高的死亡风险(风险比, 1.02; 95%CI, 1.07-1.35)。
       研究人员得出了最终的结果,在患有晚期NSCLC的享有医疗保险的人群中,与卡铂+吉西他滨、卡铂+多西他赛的化疗方案相比,卡铂+紫杉醇的方案更能延长病人的生存期。这样的化疗方案尤其对组织病理学诊断为鳞状细胞癌的患者有益。

肺癌相关的拓展阅读:


Comparative effectiveness of three platinum-doublet chemotherapy regimens in elderly patients with advanced non-small cell lung cancer.
Abstract
BACKGROUND: Randomized trials report equivalent efficacy among various combinations of platinum-based regimens in advanced non-small cell lung cancer (NSCLC). Their relative effectiveness and comparability based on squamous versus nonsquamous histology is uncertain.
METHODS: The authors used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to identify first-line chemotherapy agents administered to Medicare beneficiaries with stage IIIB or IV NSCLC diagnosed from 2000 to 2007. Overall survival was compared between patients who received the 3 most common regimens: carboplatin-paclitaxel, carboplatin-gemcitabine, and carboplatin-docetaxel. Stratified analyses distinguished between the outcomes of patients with squamous versus nonsquamous cell histology. Multivariable Cox proportional hazards models and propensity score analyses facilitated adjustment for imbalance in measurable patient characteristics.
RESULTS: Of the 15,318 patients who received first-line chemotherapy, 43.1% received carboplatin-paclitaxel, 14.3% received carboplatin-gemcitabine, 8.5% received carboplatin-docetaxel, and 34.1% received other regimens. The median survival was 8.0 months (interquartile range [IQR], 3.5-17.4 months) for carboplatin-paclitaxel, 7.3 months (IQR, 3.4-15.2 months) for carboplatin-gemcitabine, and 7.5 months (IQR, 3.2-16.0 months) for carboplatin-docetaxel. Both multivariable and propensity score-adjusted Cox models demonstrated a slight inferiority associated with carboplatin-gemcitabine or carboplatin-docetaxel versus carboplatin-paclitaxel, with a hazard ratio of 1.10 (95% confidence interval, 1.04-1.15) and 1.09 (95% confidence interval, 1.02-1.16), respectively, in propensity score-stratified models. Among the subgroup of 2063 patients with squamous carcinoma, propensity score-stratified analyses had a higher risk of death (hazard ratio, 1.20; 95% confidence interval, 1.07-1.35) associated with carboplatin-gemcitabine versus carboplatin-paclitaxel.
CONCLUSIONS: Carboplatin-paclitaxel was associated with slightly better survival compared with carboplatin-gemcitabine or carboplatin-docetaxel within the Medicare population with advanced NSCLC, and this was most pronounced for patients who had squamous cell histology. Cancer 2013;. © 2013 American Cancer Society.



小提示:78%用户已下载梅斯医学APP,更方便阅读和交流,请扫描二维码直接下载APP

所属期刊:CANCER CYTOPATHOL 期刊论坛:进入期刊论坛

只有APP中用户,且经认证才能发表评论!马上下载

web对话