免疫治疗药物治疗非小细胞肺癌的有效性和安全性分析

【作者】 陆晶晶；

【导师】 张彩伢；

【作者基本信息】 浙江大学 ， 概率论与数理统计， 2017， 硕士

【摘要】 目的:通过荟萃分析、统计检验评价与比较三种免疫治疗药物对非小细胞肺癌(NSCLC)的有效性与安全性,为以后NSCLC患者的临床治疗决策提供参考依据。方法:首先通过计算机检索 Cochrane Library、Web of Science、PubMed,收集所有关于 Pembrolizumab (10mg/kg)、Nivolumab (3mg/kg)和 Atezolizumab(1200mg)这三种免疫治疗药物相应剂量下用于治疗非小细胞肺癌的随机对照试验(randomized controlled trial,RCT)。利用 RevMan 5.3 软件对所纳入文献进行统计学分析。利用列联表的独立性检验和两独立样本的t检验,比较三种药物的疗效指标。结果:初次检索获得相关文献749篇,经过阅读文题、摘要,初步排除了710篇重复及明显不符合纳入标准的文献,并根据纳入排除标准阅读全文后排除27篇,最终有12篇符合本次评价的纳入标准。Pembrolizumab、Nivolumab和Atezolizumab三种药物治疗非小细胞肺癌的客观缓解率分别为17.94%、19.39%和24.39%。应用列联表的独立性检验得,P_=0.0065<0.01。Nivolumab 和 Atezolizumab两种药物治疗非小细胞肺癌的3级及3级以上不良事件发生率分别为10.84%和33.47%。应用列联表的独立性检验得,P_<0.001。结论:总体来看,nivolumab和atezolizumab均是有希望的非小细胞肺癌二线治疗药物,且耐受性较好。但是由于数据有限,无法比较更多的疗效指标。更多还原

【Abstract】 Objective: To evaluate and compare with the efficacy and safety of these three immune therapy drugs for non-small cell lung cancer, and to provide the reference for treatment and making decision in NSCLC.Methods: Relevant randomized controlled trials (RCTs) were searched in Cochrane Library, Web of Science and PubMed. RCTs of pembrolizumab (10mg/kg),nivolumab (3mg/kg) and atezolizumab (1200mg) for NSCLC were included. These included studies were analyzed by the Cochrane Collaboration’s RevMan 5.3 software.We compared with the efficacy and safety of the three drugs by Chi-square test and t-test.Results: The original search identified 749 articles in electronic database. We excluded 710 articles after review of the title and abstract. By assessing the accordance of the remaining articles with the predefined inclusion criteria, we excluded 27 articles after review of the article. Finally, 12 articles were considered eligible for inclusion in the meta-analysis. The ORR of pembrolizumab , nivolumab and atezolizumab were 17.94%,19.39% and 24.39%, respectively(P_=0.0065<0.01).The ≥ grade 3 AEs rate of nivolumab and atezolizumab were 10.84% and 33.47%,respectively(P_<0.001).Conclusion: Generally speaking, both nivolumab and atezolizumab were promising second-line drugs for NSCLC. They were well tolerated. Because of the limit of data we could not compare more results.更多还原