Chemotherapy for advanced gastric cancer
Top Cited Papers
- 17 March 2010
- reference entry
- research article
- Published by Wiley
- No. 3,p. CD004064
- https://doi.org/10.1002/14651858.cd004064.pub3
Abstract
Background Gastric cancer currently ranks second in global cancer mortality. Most patients are either diagnosed at an advanced stage, or develop a relapse after surgery with curative intent. Apart from supportive care and palliative radiation to localized (e.g. bone) metastasis, systemic chemotherapy is the only treatment option available in this situation. Objectives To assess the efficacy of chemotherapy versus best supportive care, combination versus single agent chemotherapy and different combination chemotherapy regimens in advanced gastric cancer. Search methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE up to March 2009, reference lists of studies, and contacted pharmaceutical companies and national and international experts. Selection criteria Randomised controlled trials on systemic intravenous chemotherapy versus best supportive care, combination versus single agent chemotherapy and different combination chemotherapies in advanced gastric cancer. Data collection and analysis Two authors independently extracted data. A third investigator was consulted in case of disagreements. We contacted study authors to obtain missing information. Main results Thirty five trials, with a total of 5726 patients, have been included in the meta‐analysis of overall survival. The comparison of chemotherapy versus best supportive care consistently demonstrated a significant benefit in overall survival in favour of the group receiving chemotherapy (hazard ratios (HR) 0.37; 95% confidence intervals (CI) 0.24 to 0.55, 184 participants). The comparison of combination versus single‐agent chemotherapy provides evidence for a survival benefit in favour of combination chemotherapy (HR 0.82; 95% CI 0.74 to 0.90, 1914 participants). The price of this benefit is increased toxicity as a result of combination chemotherapy. When comparing 5‐FU/cisplatin‐containing combination therapy regimens with versus without anthracyclines (HR 0.77; 95% CI 0.62 to 0.95, 501 participants) and 5‐FU/anthracycline‐containing combinations with versus without cisplatin (HR 0.82; 95% CI 0.73 to 0.92, 1147 participants) there was a significant survival benefit for regimens including 5‐FU, anthracyclines and cisplatin. Both the comparison of irinotecan versus non‐irinotecan (HR 0.86; 95% CI 0.73 to 1.02, 639 participants) and docetaxel versus non‐docetaxel containing regimens (HR 0.93; 95% CI 0.75 to 1.15, 805 participants) show non‐significant overall survival benefits in favour of the irinotecan and docetaxel‐containing regimens. Authors' conclusions Chemotherapy significantly improves survival in comparison to best supportive care. In addition, combination chemotherapy improves survival compared to single‐agent 5‐FU. All patients should be tested for their HER‐2 status and trastuzumab should be added to a standard fluoropyrimidine/cisplatin regimen in patients with HER‐2 positive tumours. Two and three‐drug regimens including 5‐FU, cisplatin, with or without an anthracycline, as well as irinotecan or docetaxel‐containing regimens are reasonable treatment options for HER‐2 negative patients.Keywords
This publication has 137 references indexed in Scilit:
- Second-line chemotherapy for patients with advanced gastric cancer: who may benefit?British Journal of Cancer, 2008
- A randomised multicentre phase II trial of capecitabine vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancerBritish Journal of Cancer, 2008
- S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trialThe Lancet Oncology, 2008
- Capecitabine and Oxaliplatin for Advanced Esophagogastric CancerThe New England Journal of Medicine, 2008
- Palliative Care: The World Health Organization's Global PerspectiveJournal of Pain and Symptom Management, 2002
- How should meta‐regression analyses be undertaken and interpreted?Statistics in Medicine, 2002
- A prospective randomized phase III trial of 5-fluorouracil and cisplatin (FP) versus epirubicin, cisplatin, and 5-fu (ECF) in the treatment of patients with previously untreated advanced gastric cancer (AGC)European Journal of Cancer, 2001
- Eight-hour infusion versus bolus injection of doxorubicin in EAP regimen in patients with advanced gastric cancer (AGC): a prospective randomised trialEuropean Journal of Cancer, 1999
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996
- Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancerBritish Journal of Cancer, 1995