Antibiotik antitumor mengandungi komposisi aturan untuk kanser payudara metastatik
Abstract
Background
Antitumour antibiotics are used in the management of metastatic breast cancer. Some of these agents have demonstrated higher tumour response rates than non‐antitumour antibiotic regimens, however a survival benefit has not been established in this setting.
Objectives
To review the randomised evidence comparing antitumour antibiotic containing chemotherapy regimens with regimens not containing an antitumour antibiotic in the management of women with metastatic breast cancer.
Search methods
The Specialised Register maintained by the Cochrane Breast Cancer Group was searched on 3rd October, 2006 using the codes for 'advanced breast cancer' and 'chemotherapy'. Details of the search strategy and coding applied by the Group to create the register are described in the Group's module on The Cochrane Library.
Selection criteria
Randomised trials comparing antitumour antibiotic containing regimens with regimens not containing antitumour antibiotics in women with metastatic breast cancer.
Data collection and analysis
Data were collected from published trials. Studies were assessed for eligibility and quality, and data were extracted by two independent reviewers. Hazard Ratios (HRs) were derived from time‐to‐event outcomes where possible, and a fixed effect model was used for meta‐analysis. Response rates were analysed as dichotomous variables. Quality of life and toxicity data were extracted where present. A primary analysis was conducted for all trials and by class of antitumour antibiotic.
Main results
Thirty‐four trials reporting on 46 treatment comparisons were identified. All trials published results for tumour response and 27 trials published time‐to‐event data for overall survival. The observed 4244 deaths in 5605 randomised women did not demonstrate a statistically significant difference in survival between regimens that contained antitumour antibiotics and those that did not (HR 0.96, 95% CI 0.90 to 1.02, P = 0.22) and no significant heterogeneity. Antitumour antibiotic regimens were favourably associated with time‐to‐progression (HR 0.84, 95% CI 0.77 to 0.91) and tumour response rates (odds ratio (OR) 1.33, 95% CI 1.21 to 1.48) although statistically significant heterogeneity was observed for these outcomes. These associations were consistent when the analysis was restricted to the 30 trials that reported on anthracyclines. Patients receiving anthracycline containing regimens were also more likely to experience toxic events compared to patients receiving non‐antitumour antibiotic regimens. No statistically significant difference was observed in any outcome between mitoxantrone containing and non‐antitumour antibiotic‐containing regimens.
Authors' conclusions
Compared to regimens without antitumour antibiotics, regimens that contained these agents showed a statistically significant advantage for tumour response and time to progression in women with metastatic breast cancer but were not associated with an improvement in overall survival. The favourable effect on tumour response and time to progression observed in anthracycline containing regimens was also associated with greater toxicity.
PICO
Plain language summary
Antibiotik antitumor mengandungi komposisi aturan untuk kanser payudara metastatik
Kanser payudara lanjutan (metastatik) merupakan kanser yang telah merebak ke luar kawasan payudara. Rawatan untuk penyakit metastatik biasanya melibatkan beberapa jenis kemoterapi (ubat anti‐barah) untuk cuba mengurangkan barah. Ubat kemoterapi boleh diberikan sebagai agen tunggal atau bersama dengan ubat kemoterapi yang lain. Ini dilakukan mengikut rancangan atau komposisi aturan ubat yang disebut sebagai regim. Terdapat banyak jenis ubat kemoterapi yang berfungsi dengan pelbagai cara. Antibiotik antitumour berfungsi dengan merosakkan sel barah, seterusnya mencegah sel tersebut daripada membiak. Kemoterapi secara amnya menghasilkan pelbagai kesan sampingan atau kesan buruk yang berkaitan dengan rawatan. Kesan sampingan antibiotik antitumor yang diketahui termasuk loya, muntah, pengurangan jumlah sel darah putih (dikenali sebagai leukopenia), dan dalam beberapa kes reaksi toksik yang mengubah kerja jantung (disebut kardiotoksisitas).
Ulasan ini bertujuan untuk mengenal pasti dan mengkaji bukti rawak yang membandingkan rawatan kemoterapi yang mengandungi antibiotik antitumor dengan rawatan yang tidak mengandungi antibiotik antitumor. Ulasan ini telah mengenal pasti 34 kajian yang melibatkan 5605 orang wanita. Ulasan ini mendapati bahawa bagi wanita dengan kanser payudara lanjut, pengambilan antibiotik antitumour tidak menghasilkan kelangsungan hidup yang lebih baik daripada wanita yang mengambil jenis ubat kemoterapi yang lain. Walaupun kekurangan bukti manfaat untuk kelangsungan hidup, tinjauan ini telah menunjukkan bahawa wanita yang mengambil ubat‐ubat tersebut mempunyai kelebihan dalam masa perkembangannya (jangka masa yang diperlukan untuk kanser berkembang setelah mengambil ubat) dan tindak balas tumor (penyusutan tumor) berbanding dengan wanita yang tidak mengambil ubat antibiotik antitumour. Namun begitu, risiko kesan sampingan termasuk kardiotoksisitas, leukopenia dan loya/muntah semuanya meningkat dengan ketara dalam kalangan wanita yang mengambil antibiotik antitumor. Memandangkan bahawa, tinjauan ini gagal menunjukkan manfaat dalam kelangsungan hidup bagi wanita yang mengambil kumpulan ubat ini tetapi sebaliknya menunjukkan kadar kesan sampingan yang lebih tinggi, penggunaan ubat‐ubatan ini dalam pengurusan kanser payudara metastatik mesti dipertimbang dengan teliti terhadap risiko kesan‐kesan sampingan tersebut.
