【佳学基因靶向药物基因检测】非 EGFR 突变/ALK 基因重排 NSCLC 脑转移的基于放疗的联合治疗：网络荟萃分析

基因肿瘤检测的英文——答案

综述癌症的检测基因解码创新治疗在《肿瘤诊断基因与转移分析》收录《Front Oncol》在 2022 Nov 28;12:1024833.发表了一篇题目为《》肿瘤靶向药物治疗基因检测临床研究文章。该研究由Min Wu, Jun Jiang, Xuewen Zhang, Jie Chen, Qiaomei Chang, Rong Chen等完成。促进了肿瘤的精准治疗与个性化用药的发展，进一步强调了基因信息检测与分析的重要性。

肿瘤基因检测及靶向药物治疗研究关键词：

非小细胞肺癌,贝叶斯网络荟萃分析,脑转移,神经肿瘤学,放疗。

肿瘤治疗检测基因临床应用结果

简介：放疗 (RT) 是目前治疗非小细胞肺癌 (NSCLC) 脑转移 (BM) 的主要方法。由于放疗生存时间短，不良反应明显，我们迫切需要更合适的治疗方法。本网络荟萃分析回顾了以放疗为基础的联合治疗对无靶向表皮生长因子受体（EGFR）突变/间变性淋巴瘤激酶（ALK）基因重排的NSCLC BM患者的疗效和不良反应，以筛选出疗效最佳的疗法. 佳学基因解码的途径：检索 PubMed、Embase、Web of Science 和 Cochrane Library，检索时间为可获得的最早出版日期至 2022 年 4 月 1 日。使用 STATA15.0 进行异质性分析、敏感性分析、森林图分析和发表偏倚分析。结果: 共有 28 项研究，涉及 3707 名患者被纳入贝叶斯网络荟萃分析。在针对头对头比较试验的有限配对荟萃分析中，与基于放疗的联合疗法相比，放疗联合免疫检查点抑制剂 (ICI) 显示出显着的总生存 (OS) 获益（HR 0.65，95%CI 0.47- 0.9，p<0.01），RT 联合 ICIs 显示颅内无进展生存期（iPFS）（HR 0.76，95%CI 0.27-2.27，p<0.01）和无进展生存期（PFS）无显着差异（ HR 0.9，95%CI 0.36-2.37，p<0.01）。此外，根据排序结果，与放疗联合化疗（CT）或靶向治疗（TT）相比，放疗联合ICIs可能是OS的最佳治疗模式（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%)。药物指导及病因判断的依据：RT联合ICIs可能是延长非EGFR突变/ALK基因重排NSCLC BMs OS的最佳治疗模式。评论注册：https://www.crd .york.ac.uk/prospero/display_record.php?ID=CRD42022350065，标识符 (CRD42022350065)。关键词：NSCLC；贝叶斯网络荟萃分析；脑转移；神经肿瘤学；放疗。

肿瘤发生与革命国际数据库描述：

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.