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注册即可获取德孚的最新动态
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Authors Dai P, Li J, Ma XP, Huang J, Meng JJ, Gong P
Received 9 August 2017
Accepted for publication 25 November 2017
Published 5 February 2018 Volume 2018:11 Pages 721—730
DOI https://doi.org/10.2147/OTT.S148670
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Jianmin Xu
Background: The study of cyclooxygenase-2 (COX-2) inhibitors is now mired in
controversy. We performed a meta-analysis to assess the efficacy and safety
profile of COX-2 inhibitors in patients with advanced non-small-cell lung
cancer (NSCLC).
Patients and methods: A literature search of PubMed, EMBASE, the
Cochrane Central databases, and ClinicalTrials.gov, up until March 26, 2017,
identified relevant randomized controlled trials. Data analysis was performed
using Stata 12.0.
Results: Six eligible trials (1,794 patients) were selected
from the 407 studies that were identified initially. A significant difference,
favoring COX-2 inhibitors plus chemotherapy over chemotherapy alone, was
observed in the overall response rate (relative risk [RR] =1.25, 95% confidence
interval [CI]: 1.06–1.48). Further, we conducted two subgroup analyses
according to the type of COX-2 inhibitors (celecoxib, rofecoxib, or apricoxib)
and treatment line (first or second chemotherapy). The first-line treatment
includes: NP (changchun red bean + cisplatin or carboplatin), GP (double
fluorine cytidine + cisplatin or carboplatin), or TP (paclitaxel + cisplatin or
carboplatin, docetaxel + cisplatin or carboplatin). The second-line treatment
includes two internationally recognized compounds, one is docetaxel and the
other is the pemetrexed, both of which are individually selected. In subgroup
analysis, significantly increased overall response rate (ORR) results were
found for rofecoxib plus chemotherapy (RR =1.56, 95% CI: 1.08–2.25) and COX-2
inhibitor given with first-line chemotherapy (RR =1.27, 95% CI: 1.07–1.50).
However, there was no difference between COX-2 inhibitors plus chemotherapy and
chemotherapy alone in overall survival (hazard ratio [HR] =1.04, 95% CI:
0.91–1.18), progression-free survival (HR =0.97, 95% CI: 0.86–1.10), and 1-year
survival rate (RR =1.03, 95% CI: 0.89–1.20). Toxicity did not differ
significantly between COX-2 inhibitors plus chemotherapy and chemotherapy alone
with the exception of leukopenia (RR =1.21, 95% CI: 1.03–1.42),
thrombocytopenia (RR =1.32, 95% CI: 1.04–1.67), and cardiovascular events (RR
=2.39, 95% CI: 1.06–5.42). The results of the Egger’s test indicated no
significant difference in primary outcomes.
Conclusion: COX-2 inhibitors improved ORR of advanced NSCLC with
chemotherapy, but had no effect on survival indices. Moreover, COX-2 inhibitors
may lead to higher rates of hematologic toxicities and cardiovascular events.
Keywords: cyclooxygenase-2
inhibitors, non-small-cell lung cancer, chemotherapy, overall survival,
meta-analysis