含抗腫瘤抗生素的轉移性乳癌治療方案
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
淺顯易懂的口語結論
含抗腫瘤抗生素的轉移性乳癌治療方案
晚期 (轉移性) 乳癌代表癌症已經擴散到乳房之外。通常以某種類型的化學療法 (抗癌藥物) 來治療轉移性癌症。化學治療藥物可以使用單一藥物治療或與其他化學治療藥物合併治療。這是根據藥物治療的計劃或療程來擬定。目前有許多類型的化學治療藥物以不同的方式作用。抗腫瘤抗生素可藉由破壞癌細胞，從而抑制這些細胞增生。化學治療通常會發生許多與治療相關的副作用或不良事件。抗腫瘤抗生素的已知副作用包括噁心、嘔吐、白血球數量減少 (稱為白血球減少症)，在某些情況下還包括改變心臟功能的毒性反應 (稱為心臟毒性)。
這篇回顧文章評估隨機分派臨床證據，比較包含抗腫瘤抗生素的化療療程和不含抗腫瘤抗生素療程的臨床試驗。這篇回顧文章納入34個臨床試驗，包括5605名婦女。這篇回顧發現，對於患有晚期乳癌的女性，使用抗腫瘤抗生素治療沒有比使用其他類型的化療藥物治療具有更佳的存活期。儘管缺乏增加存活期的證據，這篇回顧文章說明，與未服用抗腫瘤抗生素藥物的女性相比，服用這些藥物治療的婦女在延長疾病惡化時間 (服用藥物治療後延緩癌症惡化所花費的時間) 和腫瘤反應 (腫瘤縮小) 方面具有優勢。然而，服用抗腫瘤抗生素治療的婦女明顯增加包括心臟毒性、白血球減少和噁心/嘔吐在內的副作用風險。鑑於這篇回顧性文章未能顯示出服用該類藥物的婦女能增加存活期，且副作用發生率較高。因此必須謹慎權衡在治療轉移性乳癌中使用這些藥物治療的效益和風險。
