Abstract
BackgroundThe aim of our meta-analysis is to assess the efficacy and safety of the target combined chemotherapy for the patients with unresectable advanced or recurrent gastric cancer.MethodsIn accordance with the standard meta-analysis procedures, the patients included in our study were with unresectable advanced or recurrent gastric cancer and allocated randomly to receive target combined chemotherapy or the traditional chemotherapy. The search was applied to PubMed, EMBASE, Science Citation Index Expanded, Cocran’s library (from inception to February 2016). All analyses were performed by STATA 12.0, with the odds ratio, hazard ratio, and 95 % confidence interval as the effect measures.ResultsFourteen studies were included in this meta-analysis. A total of 5067 patients with advanced gastric cancer were divided into two arms: traditional chemotherapy arm and target combined chemotherapy arm. A significant improvement for overall survival (hazard ratio was 0.89, 95 % confidence interval: 0.83–0.95) and overall response rate (odds ratio was 1.44, 95 % confidence interval: 1.15–1.81) was observed, but no significant difference was found for progression-free survival (hazard ratio was 0.89, 95 % confidence interval: 0.77–1.00) in the target combined chemotherapy arm. In subgroup analysis, increasing benefits regarding overall survival and progression-free survival were found in anti epidermal growth factor receptor target drugs for selected patients subgroup and anti vascular endothelial growth factor receptor target drugs for unselected patients subgroup, but not in anti epidermal growth factor receptor target drugs for unselected patients subgroup. Besides, some adverse events were increased in the target combined chemotherapy arm.ConclusionsThe target combined chemotherapy represented a better overall survival benefit and treatment efficiency and higher incidence of some grade 3–4 adverse events than the traditional chemotherapy for patients with unresectable advanced or recurrence gastric cancer. The anti vascular endothelial growth factor receptor drugs can improve the efficacy in the whole patients with unresectable advanced or recurrence gastric cancer and the anti epidermal growth factor receptor target drugs can only improve the efficacy in the epidermal growth factor receptor positive patients.
Highlights
The aim of our meta-analysis is to assess the efficacy and safety of the target combined chemotherapy for the patients with unresectable advanced or recurrent gastric cancer
The prognosis is very poor in these patients and chemotherapy represents the reference treatment determining a significantly higher survival benefit compared with the best supportive care alone [3]
The sufficient data to calculate a hazard ratio (HR) and 95 % confidence interval for overall survival (OS) and progression-free survival (PFS) and a odds ratio (OR) with 95 % CI for overall response rate (ORR) and adverse events should be available; (3) randomized controlled trials of II phase and III phase; (4) more than 20 patients involved in the trails; (5) articles published in English language; (6) Similar studies or the same research retrieved the recently published article
Summary
The aim of our meta-analysis is to assess the efficacy and safety of the target combined chemotherapy for the patients with unresectable advanced or recurrent gastric cancer. Most of patients show an advanced disease or distant metastasis at diagnosis and lose the opportunity of surgical treatment. Most of the patients relapsed after a prior curative surgical approach. The prognosis is very poor in these patients and chemotherapy represents the reference treatment determining a significantly higher survival benefit compared with the best supportive care alone [3]. Despite the use of the latest chemotherapy regimen, the median survival time of patients with advanced gastric cancer was only about 10 months [4]. It is important to change the existing strategies and find more effective combination chemotherapy for the advanced gastric cancer
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