关键临床试验支持脂质体伊立替康 (nal-IRI) 加氟尿嘧啶/亚叶酸对既往接受吉西他滨治疗的胰腺导管腺癌 (PDAC) 患者的生存获益。由于对 IRI 潜在的交叉耐药性，人们担心 nal-IRI 对接受 FOLFIRINOX（氟尿嘧啶、亚叶酸、IRI 和奥沙利铂联合用药）患者的益处。本荟萃分析的目的是描述晚期 PDAC 患者先前接受过 IRI 对 nal-IRI 治疗方案结局的影响。真实世界研究评估了先前接受过 IRI 的患者的 nal-IRI 结局使用电子数据库检索截至 2023 年 4 月发布的内容。使用随机效应模型进行荟萃分析，以估计汇总风险比 (HR) 和 95% 置信区间 (CI)。纳入了八项研究（n = 1368 名患者）。合并中位无进展生存期 (PFS) 为 2.02 个月（95% CI，1.43-2.57 个月），中位总生存期 (OS) 为 4.26 个月（95% CI，3.03-5.39 个月）。既往接触过 IRI 的患者的 PFS（HR，1.17；95% CI，0.94-1.47；p = .17）和 OS（HR，1.16；95% CI，0.95-1.42；p = .16）与未接触过 IRI 的患者相当IRI 曝光。同样，接受传统 IRI 治疗后疾病进展的患者具有 PFS（HR，1.50；95% CI，0.73-3.08；p = .24）和 OS（HR，1.70；95% CI，0.68-4.27；p = .26） nal-IRI 与无进展性疾病的患者相当。先前的 IRI 暴露不会影响晚期 PDAC 患者的 nal-IRI 方案的生存结果。后续化疗方案的选择应基于不同的安全性、患者状况、治疗成本以及与健康相关的生活质量。© 2024 美国癌症协会。

Pivotal clinical trials supported survival benefits of liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin in patients with pancreatic ductal adenocarcinoma (PDAC) who previously received gemcitabine-based therapy. There are concerns about the benefits of nal-IRI in patients who received FOLFIRINOX (combined fluorouracil, leucovorin, IRI, and oxaliplatin) because of potential cross-resistance to IRI. The objective of this meta-analysis was to characterize the impact of the previous receipt of IRI on the outcomes of nal-IRI regimens in patients with advanced PDAC.Real-world studies evaluating the outcomes of nal-IRI in patients who had prior IRI exposure published up to April 2023 were searched using electronic databases. The meta-analysis was conducted using a random effects model to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).Eight studies (n = 1368 patients) were included. The pooled median progression-free survival (PFS) was 2.02 months (95% CI, 1.43-2.57 months), and the median overall survival (OS) was 4.26 months (95% CI, 3.03-5.39 months). Patients with prior IRI exposure had PFS (HR, 1.17; 95% CI, 0.94-1.47; p = .17) and OS (HR, 1.16; 95% CI, 0.95-1.42; p = .16) comparable to patients without prior IRI exposure. Likewise, patients who had progressive disease on conventional IRI had PFS (HR, 1.50; 95% CI, 0.73-3.08; p = .24) and OS (HR, 1.70; 95% CI, 0.68-4.27; p = .26) with nal-IRI comparable to patients who had no progressive disease.Prior IRI exposure does not affect the survival outcomes of nal-IRI regimens in patients who have advanced PDAC. The selection of later lines of chemotherapy regimens should be based on the differential safety profile, patient status, the cost of treatment, and health-related quality of life.© 2024 American Cancer Society.