Doxorubicin-Based Chemotherapy for the Palliative Treatment of AdultPatients with Locally Advanced or Metastatic Soft-Tissue Sarcoma:A Meta-Analysis and Clinical Practice Guideline

[摘要] Purpose.To make recommendations for the use of doxorubicin-basedchemotherapy in patients with soft-tissue sarcoma.Patients.The recommendations apply to patients with symptomaticunresectable locally advanced or metastatic soft-tissue sarcoma who are candidates forpalliative chemotherapy.Methods.A systematic review of the published literature was combinedwith a consensus process around the interpretation of the evidence in the context ofconventional practice to develop an evidence-based practice guideline.Results.Eight randomized trials comparing doxorubicin-based combinationversus doxorubicin single-agent chemotherapy were reviewed. Response rates and overallsurvival were evaluated using pooled statistical analysis.The pooled response data in 2281patients showed a slight trend favouring the combination therapy, although this did not reachstatistical significance (odds ratio (OR), 0.79; 95% confidence interval (CI), 0.60–1.05;p=0.10).Survival data could only be abstracted from six studies involving 2097 patients, and showedno significant advantage for combination therapy (OR, 0.84; 95% CI, 0.67–1.06;p=0.13).Data on adverse effects could not be combined in a meta-analysis; however nausea,vomiting and myelosuppression were consistently more severe with combinationchemotherapy than with single-agent chemotherapy.Discussion.Single-agent doxorubicin is an appropriate first-linechemotherapy option for advanced or metastatic soft-tissue sarcoma. Some doxorubicin-basedcombination chemotherapy regimens, given in conventional doses, produce only marginalincreases in response rates, at the expense of increased adverse effects, and with noimprovements in overall survival. Future randomized clinical trials should compare newregimens, whose activity has been established in single-arm studies, with single-agent doxorubicin, and include quality of life as an outcome measure.

[学科分类] 肿瘤学