【佳學基因靶向藥物基因檢測】非 EGFR 突變/ALK 基因重排 NSCLC 腦轉移的基于放療的聯合治療：網絡薈萃分析

基因腫瘤檢測的英文——答案

綜述癌癥的檢測基因解碼創(chuàng)新治療在《腫瘤診斷基因與轉移分析》收錄《Front Oncol》在?2022 Nov 28;12:1024833.發(fā)表了一篇題目為《》腫瘤靶向藥物治療基因檢測臨床研究文章。該研究由Min Wu,?Jun Jiang,?Xuewen Zhang,?Jie Chen,?Qiaomei Chang,?Rong Chen等完成。促進了腫瘤的正確治療與個性化用藥的發(fā)展，進一步強調了基因信息檢測與分析的重要性。

腫瘤基因檢測及靶向藥物治療研究關鍵詞：

非小細胞肺癌,貝葉斯網絡薈萃分析,腦轉移,神經腫瘤學,放療。

腫瘤治療檢測基因臨床應用結果

簡介：放療 (RT) 是目前治療非小細胞肺癌 (NSCLC) 腦轉移 (BM) 的主要方法。由于放療生存時間短，不良反應明顯，我們迫切需要更合適的治療方法。本網絡薈萃分析回顧了以放療為基礎的聯合治療對無靶向表皮生長因子受體（EGFR）突變/間變性淋巴瘤激酶（ALK）基因重排的NSCLC BM患者的療效和不良反應，以篩選出療效最佳的療法. 佳學基因解碼的途徑：檢索 PubMed、Embase、Web of Science 和 Cochrane Library，檢索時間為可獲得的最早出版日期至 2022 年 4 月 1 日。使用 STATA15.0 進行異質性分析、敏感性分析、森林圖分析和發(fā)表偏倚分析。結果: 共有 28 項研究，涉及 3707 名患者被納入貝葉斯網絡薈萃分析。在針對頭對頭比較試驗的有限配對薈萃分析中，與基于放療的聯合療法相比，放療聯合免疫檢查點抑制劑 (ICI) 顯示出顯著的總生存 (OS) 獲益（HR 0.65，95%CI 0.47- 0.9，p<0.01），RT 聯合 ICIs 顯示顱內無進展生存期（iPFS）（HR 0.76，95%CI 0.27-2.27，p<0.01）和無進展生存期（PFS）無顯著差異（ HR 0.9，95%CI 0.36-2.37，p<0.01）。此外，根據排序結果，與放療聯合化療（CT）或靶向治療（TT）相比，放療聯合ICIs可能是OS的最佳治療模式（ICIs+RT vs CT+RT vs TT+RT ；91.9% vs. 27.8% vs. 29.3%，iPFS（ICIs+RT vs CT+RT vs TT+RT，46.9% vs. 25.2% vs. 25.6%）和 PFS（ICIs+RT vs CT+RT vs TT+RT， 36.2% vs 31% vs 36.5%)。藥物指導及病因判斷的依據：RT聯合ICIs可能是延長非EGFR突變/ALK基因重排NSCLC BMs OS的最佳治療模式。評論注冊：https://www.crd .york.ac.uk/prospero/display_record.php?ID=CRD42022350065，標識符 (CRD42022350065)。關鍵詞：NSCLC；貝葉斯網絡薈萃分析；腦轉移；神經腫瘤學；放療。

腫瘤發(fā)生與革命國際數據庫描述：

Introduction:?Radiotherapy (RT) is currently the main treatment for brain metastases (BMs) from non-small cell lung cancer (NSCLC). Due to the short survival time and obvious adverse reactions of RT, we urgently need more appropriate treatment. This network meta-analysis reviewed the efficacy and adverse effects of radiotherapy-based combination therapy for patients without targeted epidermal growth factor receptor (EGFR) mutations/anaplastic lymphoma kinase (ALK) gene rearrangement NSCLC BMs, to screen out the therapy with the best efficacy.Methods:?PubMed, Embase, Web of Science, and Cochrane Library were searched from the earliest publication date available to 1 April 2022. STATA15.0 was used to conduct heterogeneity analysis, sensitivity analysis, forest plot analysis, and publication bias analysis.Results:?A total of 28 studies, involving 3707 patients were included in the Bayesian network meta-analysis. In the limited paired meta-analysis for head-to-head comparative trials, compared with RT-based combination therapy, RT combined with Immune checkpoint inhibitors (ICIs) showed significant overall survival (OS) benefit (HR 0.65, 95%CI 0.47-0.9, p<0.01), RT combined with ICIs showed a non-significant difference for intracranial progression-free survival (iPFS) (HR 0.76, 95%CI 0.27-2.27, p<0.01) and progression-free survival (PFS) (HR 0.9, 95%CI 0.36-2.37, p<0.01). In addition, according to the ranking results, compared with RT combined with chemotherapy(CT) or with targeted therapy(TT), RT combined with ICIs might be the best treatment mode for OS(ICIs+RT vs CT+RT vs TT+RT; 91.9% vs. 27.8% vs. 29.3%, iPFS (ICIs+RT vs CT+RT vs TT+RT, 46.9% vs 25.2% vs 25.6%) and PFS (ICIs+RT vs CT+RT vs TT+RT, 36.2% vs 31% vs 36.5%).Conclusions:?RT combined with ICIs might be the best treatment mode to prolong the OS for BMs from NSCLC with non-EGFR mutation/ALK gene rearrangement.Review registration:?https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022350065, identifier (CRD42022350065).Keywords:?NSCLC; bayesian network meta-analysis; brain metastasis; neuro-oncology; radiotherapy.

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