BEACOPP强化方案有助延长霍奇金淋巴瘤患者生存时间

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一项网络meta分析显示,在治疗晚期霍奇金淋巴瘤时,采用更强烈的化疗方案可以获得明显的生存益处,但是其他专家强调这种方案的毒副作用。

这种强化化疗方案为BEACOPP(博来霉素、依托泊甙、阿霉素、环磷酰胺、长春新碱、甲苄肼和强的松),由德国开发。

这种方案在德国以外使用很少,在北美用的也不多,而一种更老的化疗方案ABVD(阿霉素、博来霉素、长春新碱和氮烯唑胺)却更受推崇。

研究表明,BEACOPP方案能够改善疾病控制,与ABDV方案相比能够延长无进展生存期(PFS)。

研究结果发表在《柳叶刀 肿瘤学》(Lancet Oncology)。

Background

Several treatment strategies are available for adults with advanced-stage Hodgkin's lymphoma, but studies assessing two alternative standards of care—increased dose bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPPescalated), and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD)—were not powered to test differences in overall survival. To guide treatment decisions in this population of patients, we did a systematic review and network meta-analysis to identify the best initial treatment strategy.

Methods

We searched the Cochrane Library, Medline, and conference proceedings for randomised controlled trials published between January, 1980, and June, 2013, that assessed overall survival in patients with advanced-stage Hodgkin's lymphoma given BEACOPPbaseline, BEACOPPescalated, BEACOPP variants, ABVD, cyclophosphamide (mechlorethamine), vincristine, procarbazine, and prednisone (C[M]OPP), hybrid or alternating chemotherapy regimens with ABVD as the backbone (eg, COPP/ABVD, MOPP/ABVD), or doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone combined with radiation therapy (the Stanford V regimen). We assessed studies for eligibility, extracted data, and assessed their quality. We then pooled the data and used a Bayesian random-effects model to combine direct comparisons with indirect evidence. We also reconstructed individual patient survival data from published Kaplan-Meier curves and did standard random-effects Poisson regression. Results are reported relative to ABVD. The primary outcome was overall survival.

Findings

We screened 2055 records and identified 75 papers covering 14 eligible trials that assessed 11 different regimens in 9993 patients, providing 59 651 patient-years of follow-up. 1189 patients died, and the median follow-up was 5·9 years (IQR 4·9—6·7). Included studies were of high methodological quality, and between-trial heterogeneity was negligible (τ2=0·01). Overall survival was highest in patients who received six cycles of BEACOPPescalated (HR 0·38, 95% credibility interval [CrI] 0·20—0·75). Compared with a 5 year survival of 88% for ABVD, the survival benefit for six cycles of BEACOPPescalated is 7% (95% CrI 3—10)—ie, a 5 year survival of 95%. Reconstructed individual survival data showed that, at 5 years, BEACOPPescalated has a 10% (95% CI 3—15) advantage over ABVD in overall survival.

Interpretation

Six cycles of BEACOPPescalated significantly improves overall survival compared with ABVD and other regimens, and thus we recommend this treatment strategy as standard of care for patients with access to the appropriate supportive care.

参考文献:Nicole Skoetz et.al. Effect of initial treatment strategy on survival of patients with advanced-stage Hodgkin's lymphoma: a systematic review and network meta-analysis. The Lancet Oncology, Volume 14, Issue 10, Pages 943 - 952, September 2013

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