Abstract
The aim of the present analysis was to compare the efficacy and safety profile of S-1-based chemotherapy (SBCT) versus capecitabine-based chemotherapy (CBCT) for advanced gastric cancer (AGC) and advanced colorectal cancer (ACRC). A meta-analysis was performed, which included eligible randomized controlled trials (RCTs) that were identified using RevMan 5.1.0 software. A total of 1,064 patients from 11 RCTs, comprising of 527 patients in the SBCT group and 537 patients in the CBCT group, were included in the analysis. For AGC, the meta-analysis of overall survival (OS) [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.85–1.12], time to progression (HR, 0.95; 95% CI, 0.80–1.12) and overall response rate (ORR) [odds ratio (OR), 1.06; 95% CI, 0.72–1.55] of patients in the SBCT group indicated no statistical significance when compared with those in the CBCT group. Furthermore, for ACRC, a pooled analysis demonstrated no significant difference between the SBCT and CBCT groups (OS: HR, 0.82; 95% CI, 0.61–1.10; progression-free survival: HR, 0.79; 95% CI=0.60–1.04; ORR: OR, 1.27; 95% CI, 0.91–1.78). The statistically significant differences identified in the overall meta-analysis indicated a low incidence of grade 3–4 hand-foot-syndrome (OR, 0.15; 95% CI, 0.06–0.36) in the SBCT group; however no statistically significant difference was observed in the incidence of grade 3–4 anemia, thrombocytopenia, leucopenia, neutropenia, diarrhea, stomatitis or nausea/vomiting. The SBCT treatment exhibited similar efficacy and an approximately equivalent safety profile compared with the CBCT treatment and was an alternative to CBCT for patients with AGC or ACRC; however, further investigation is required to provide confirmation.
Highlights
Regardless of advances in their diagnosis and treatment, gastric and colorectal cancer remain a common cause of cancer‐related mortality worldwide (1,2)
The eligible studies were included in the present meta‐analysis if they met all of the following criteria: i) Participants were patients with histologically confirmed, advanced, recurrent or metastatic colorectal or gastric cancer and did not present with severe, basic diseases which may affect the treatment effect of patients; ii) only randomized controlled trials (RCTs) were considered; iii) trials compared S‐1‐based chemotherapy (SBCT) with capecitabine‐based chemotherapy (CBCT), mono- or combined therapy of S-1 versus capecitabine, without confusion resulting from the administration of additional drugs or interventions
Concerning advanced colorectal cancer (ACRC), no trials provided the hazard ratio (HR) of time to progression (TTP) and only one trial provided progression-free survival (PFS) data (7); the HR of PFS identified no significant difference between the SBCT and CBCT group (HR= 0.79, 95% confidence interval (CI), 0.60‐1.04; Fig. 3)
Summary
Regardless of advances in their diagnosis and treatment, gastric and colorectal cancer remain a common cause of cancer‐related mortality worldwide (1,2). Acquiring curative therapy by surgery or radiotherapy is complex for patients with advanced gastric cancer (AGC) or advanced colorectal cancer (ACRC); systemic chemotherapy is considered to be the primary effective treatment. Traditional continuous infusion of 5-fluorouracil (5-FU) in combination with folinic acid has been the primary chemotherapeutic treatment for AGC and ACRC. Capecitabine is an oral fluoropyrimidine that was designed to simulate a continuous intravenous infusion of 5-FU (3) and has been approved for the treatment of patients with AGC and ACRC. As the efficacy and safety of oral fluoropyrimidines, capecitabine and S-1, have been confirmed, it is necessary to identify which treatment exhibits a greater efficacy and safety profile for AGC and ACRC patients.
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