JAMA Netw Open:铂类化疗药物基础上加用硫代硫酸钠,患者的耳毒性风险是否会更低?

2021-08-03 MedSci原创 MedSci原创

当需要铂基化疗时,应考虑预防性使用STS,进一步的大规模试验对于实际应用至关重要。

铂类化疗药是治疗儿童和成人实体瘤最常用的药物之一,广泛应用于非小细胞肺癌、卵巢癌、肝细胞瘤和头颈癌等癌症的治疗。然而,化疗药物都有一定的副作用,铂类药物的常见不良反应包括肾毒性,骨髓抑制和耳毒性。虽然预防肾毒性作用的一些医学干预措施已得到充分说明,但预防铂诱导的耳毒性作用仍然停滞不前。

近几年的研究发现,铂可以在耳蜗中无限期地持续存在,这与耳部的远期并发症有关,如感音神经性耳聋、耳鸣和前庭病等。在耳保护剂中研究最多的药物是氨磷汀,这是一种氨基硫醇前体药物,可作为活性氧清除剂,但在以前的研究中,胺磷汀未能显示出保护耳部的作用。

另一方面,硫代硫酸钠(STS)已成为一种很有前景的耳保护剂,虽然这种药物的机制之一是与顺铂共价结合,其是否会减弱抗肿瘤效果的担忧仍然存在。基于这些问题,有研究者系统性地回顾了STS与铂诱导的耳毒性作用预防相关的最新文献。探讨了STS与耳毒性效应和肿瘤相关生存率的关系以及并发因素与这些结果的关系,评估了STS在接受铂类化疗的癌症患者中的疗效。

研究者对Cochrane Library、PubMed、Embase、Web of Science、Scopus等数据库进行了搜索,截至日期为2020年11月7日。纳入接受铂基化疗的癌症患者的研究,纳入研究需比较接受STS和未接受STS的患者之间的耳毒性作用发展,并为meta分析提供了充分的信息。

研究的主要结局是比较实验组和对照组耳毒性作用发展和造血事件发展的相对危险度(rr)。次要结果为无事件生存和总生存的危险比(HRs)。最后进行敏感性分析和试验序贯分析以进一步巩固合并结果。

最后共纳入4项合格研究,包括3项随机临床试验和1项对照研究。共有278名患者被分配到实验组(基于铂类药化疗加STS)或对照组(未加STS)。总的来说,接受STS治疗的患者在铂类化疗期间耳毒性作用的风险在统计学上显著降低,而无事件生存率或总生存率较低的风险在统计学上无显著增加。

在无事件生存率(z=0.52)和总生存率(z=1.68)的试验序列分析中,尽管累积z曲线没有超过传统意义边界(两者均为1.96至1.96)或调整CI的序列监测边界,但它们没有达到所需的信息量。

硫代硫酸钠(STS)与预防耳毒性作用的总体关联

简单来说,这项研究发在以铂类药物为基础的化疗过程中使用STS与耳毒性作用的风险降低有关。此外,在合并生存估计中,接受STS和未接受STS患者的无事件生存或总生存没有统计学上的显著差异。为预防铂所致耳毒性作用提供了耳保护药物的证据。这些发现也表明,对于需要铂基化疗的患者,应考虑同时进行STS以防止耳毒性作用。

参考文献:Chen C, Huang C, Lin HH, Wang M, Chang C, Cheng Y. Association of Sodium Thiosulfate With Risk of Ototoxic Effects From Platinum-Based ChemotherapyA Systematic Review and Meta-analysisJAMA Netw Open. 2021;4(8):e2118895. doi:10.1001/jamanetworkopen.2021.18895

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createdTime=Thu Aug 05 12:08:08 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036779, encodeId=6b0c1036e7999, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 04 00:08:08 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2022-05-23 canlab
  4. 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  5. 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createdTime=Thu Aug 05 12:08:08 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036779, encodeId=6b0c1036e7999, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 04 00:08:08 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2022-05-04 feather89
  6. 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  7. 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createdTime=Thu Aug 05 12:08:08 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036779, encodeId=6b0c1036e7999, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 04 00:08:08 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2021-08-05 docwu2019
  8. 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  9. 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  10. 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createdTime=Thu Aug 05 12:08:08 CST 2021, time=2021-08-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036779, encodeId=6b0c1036e7999, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Wed Aug 04 00:08:08 CST 2021, time=2021-08-04, status=1, ipAttribution=)]
    2021-08-04 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

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