返回 
加入收藏
HER2阳性晚期胃癌二线治疗方案有效性和安全性的网状Meta分析
x
请在关注微信后，向客服人员索取文件
| 篇名： | HER2阳性晚期胃癌二线治疗方案有效性和安全性的网状Meta分析 |
| TITLE： | A network meta-analysis of the efficacy and safety of second-line treatment regimens for HER2-positive advanced gastric cancer |
| 摘要： | 目的 评价人表皮生长因子受体2（HER2）阳性晚期胃癌二线治疗方案的有效性及安全性。方法检索PubMed、中国知网等中英文数据库，收集HER2阳性晚期胃癌患者二线治疗的Ⅲ期随机对照试验（RCT），检索时限为建库至2026年4月1日。筛选文献、提取数据、评价纳入文献质量后，采用R4.3.2软件进行网状Meta分析，对各干预措施的特征性不良事件（AEs）进行描述性比较，再通过更换效应模型进行敏感性分析以评估结果的稳健性。结果共纳入5项RCT，涉及6种干预方案。有效性方面，相较于恩美曲妥珠单抗、单纯化疗、拉帕替尼+紫杉醇，安尼妥单抗+化疗可显著延长患者的中位总生存期（OS）和中位无进展生存期（PFS）（P＜0.05）。相较于雷莫西尤单抗+紫杉醇、恩美曲妥珠单抗，德曲妥珠单抗亦可显著延长患者的中位OS和中位PFS（P＜0.05），累积排序概率曲线下面积（SUCRA）排前2位的均为安尼妥单抗+化疗和德曲妥珠单抗。安全性方面，任意级别AEs发生率的SUCRA（41.6%～57.1%）总体相近；≥3级AEs及严重AEs发生率的SUCRA分别为以恩美曲妥珠单抗（19.3%）和单纯化疗（25.9%）最低；治疗相关死亡发生率的SUCRA以安尼妥单抗+化疗最低（3.7%），因AEs导致治疗中断发生率的SUCRA以德曲妥珠单抗最低（4.3%），二者SUCRA均以拉帕替尼+紫杉醇最高（78.3%、85.6%）。特征性AEs方面，间质性肺病/肺炎的发生率在德曲妥珠单抗组患者中最高（13.93%），腹泻的发生率在拉帕替尼+紫杉醇组患者中最高（77.10%），高血压主要见于雷莫西尤单抗+紫杉醇组患者（23.85%）。敏感性分析结果与主分析结果一致。结论对于HER2阳性晚期胃癌患者的二线治疗，安尼妥单抗+化疗和德曲妥珠单抗均表现出较优的OS和PFS获益趋势；安全性方面，各干预措施任意级别AEs的发生率相近，但不同方案的特征性AEs谱差异显著，临床需密切关注并实施全程化管理。 |
| ABSTRACT： | OBJECTIVE To evaluate the efficacy and safety of second-line treatment regimens for human epidermal growth factor receptor 2 （HER2）-positive advanced gastric cancer.METHODS Phase Ⅲ randomized controlled trials（RCTs） about second-line treatment regimens for HER2-positive advanced gastric cancer patients were retrieved from PubMed， CNKI， and other Chinese and English databases. The search period spanned from the inception to April 1， 2026. After screening the literature， extracting data， and assessing the quality of the included studies， a network meta-analysis was conducted using R 4.3.2 software. Descriptive comparisons of characteristic adverse events （AEs） for each intervention were performed， followed by sensitivity analyses using different effect models to evaluate the robustness of the results.RESULTS A total of 5 RCTs involving 6 intervention regimens were included. Regarding efficacy， compared with trastuzumab emtansine， chemotherapy alone， and lapatinib+paclitaxel， anbenitamab+chemotherapy significantly prolonged patients’ median overall survival （OS） and median progression-free survival （PFS） （ P ＜0.05）. Compared with ramucirumab+paclitaxel and trastuzumab emtansine， trastuzumab deruxtecan also significantly prolonged patients’ median OS and median PFS （ P ＜0.05）. The top two treatment regimens in terms of surface under the cumulative ranking curve （SUCRA） were both anbenitamab+chemotherapy and trastuzumab deruxtecan. In terms of safety， the SUCRA for the incidence of adverse events （AEs） of any grade （41.6%-57.1%） was generally similar across treatments. The SUCRA for the incidence of grade≥3 AEs and serious AEs was lowest for trastuzumab emtansine （19.3%） and chemotherapy alone （25.9%）， respectively. The SUCRA for treatment-related mortality was lowest for anbenitamab+chemotherapy （3.7%）， while the SUCRA for treatment discontinuation due to AEs was lowest for trastuzumab deruxtecan （4.3%）； for both， the SUCRA was highest for lapatinib+paclitaxel （78.3% and 85.6%， respectively）. Regarding characteristic AEs， the incidence of interstitial lung disease/pneumonitis was highest in the trastuzumab deruxtecan group （13.93%）， the incidence of diarrhea was highest in the lapatinib+paclitaxel group （77.10%）， and hypertension was primarily observed in the ramucirumab+paclitaxel group （23.85%）. The results of the sensitivity analysis were consistent with those of the main analysis.CONCLUSIONS For second-line treatment regimens of patients with HER2-positive advanced gastric cancer， both anbenitamab+chemotherapy and trastuzumab deruxtecan demonstrate a trend toward superior OS and PFS benefits； in terms of safety， the incidence rates of AEs of any grade are similar across the intervention groups， but the characteristic profiles of AEs differ significantly among the regimens， requiring close clinical monitoring and comprehensive management throughout treatment. |
| 期刊： | 2026年第37卷第18期 |
| 作者： | 李娜；黎苏；李柯蒙；黄丹雪 |
| AUTHORS： | LI Na，LI Su，LI Kemeng，HUANG Danxue |
| 关键字： | 晚期胃癌;人表皮生长因子受体2阳性;二线治疗;安尼妥单抗;德曲妥珠单抗;网状Meta分析 |
| KEYWORDS： | advanced gastric cancer;HER2-positive;second-line treatment;anbenitamab;trastuzumab deruxtecan;Network Meta-analysis |
| 阅读数： | 1 次 |
| 本月下载数： | 0 次 |
* 注：未经本站明确许可，任何网站不得非法盗链资源下载连接及抄袭本站原创内容资源!在此感谢您的支持与合作！
