Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews

X. Bonfill Cosp,G. Rodríguez-Grijalva,C. Requeijo,A. Antequera,K. Salas-Gama,A. Auladell-Rispau,M. J. Quintana,G. Urrútia,I. Solà,A. G. Meade,J. Pérez-Bracchiglione,M. Santero,R. Dorantes-Romandia,J. Salazar,R. Acosta-Dighero

doi:10.1186/s12885-021-08330-5

Abstract

BackgroundEsophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context.MethodsWe searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach.ResultsWe identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence.ConclusionsThe evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed.Trial registrationOpen Science Framework, https://doi.org/10.17605/OSF.IO/7CHX6.

Highlights

Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, poor prognosis
We registered the protocol detailing the methods in the Open Science Framework [16] and we conducted this overview according to rigorous standards aligned to Cochrane Methodology [17] and reported our results according to PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines [18]
We searched for the following outcomes: 1) overall survival (OS); 2) progression-free survival (PFS); 3) functional status (FS); 4) toxicity; 5) symptoms related to the disease; 6) quality of life (QoL); 7) admissions to hospital or long-term center, or emergency consultations; 8) quality of death

Summary

Introduction

Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, poor prognosis. While global reports have shown a decrease in gastric cancer mortality rates over the past 20 years, a steady increase in esophageal cancer rates has been observed mainly in the Western Pacific and European regions [2]. Both cancers are overly aggressive; despite their relatively low incidence, they often have a poor prognosis since the diagnosis is usually late [3, 4]. Many patients are in a terminal care period with progressive disease and months or less of expected survival which has been conceptualized by some authors as “end of life” (EOL) [6, 7]

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