Abstract
BackgroundFor patients with advanced gastric cancer (AGC), second-line chemotherapy regimen remains controversial. The efficacy and safety of irinotecan-containing doublet treatment and irinotecan monotherapy were compared in this systematic analysis.MethodsA search was conducted on EMBASE and Medline databases. All articles compared irinotecan-containing doublet to irinotecan as second-line chemotherapy for AGC. STATA statistical software (Version 12.0) was used to analyze the data.ResultsSeven studies, including 905 cases, were included in the analysis. Irinotecan-containing doublet treatment significantly prolonged progression-free survival compared to irinotecan monotherapy (HR = 0.82, 95% CI: 0.70–0.95). However, doublet treatment neither significantly prolong overall survival compared to monotherapy (HR = 0.94, 95% CI: 0.81–1.10), nor did it significantly increase the overall response rates and disease control rates, when compared to monotherapy. In addition, the irinotecan-containing doublet group had an increase in incidences of ≥ Grade 3 neutropenia (RR = 1.23, 95% CI: 1.01–1.51) and anemia (RR = 2.00, 95% CI: 1.37–2.92).ConclusionsWhen compared to irinotecan monotherapy, irinotecan-containing doublet treatment increased progression free survival and was tolerable as a second- line chemotherapy for AGC.
Highlights
For patients with advanced gastric cancer (AGC), second-line chemotherapy regimen remains controversial
For overall response rate (ORR) and disease control rate (DCR), risk ratio (RR) > 1 indicated irinotecan-containing doublet was more effective than irinotecan monotherapy; for toxicities, RR > 1 indicated more adverse effect occurred in irinotecan-containing doublet group
Our meta-analysis showed that irinotecan-containing doublet did not significantly prolong overall survival (OS) or improve ORR and DCR compared to irinotecan monotherapy
Summary
For patients with advanced gastric cancer (AGC), second-line chemotherapy regimen remains controversial. The efficacy and safety of irinotecan-containing doublet treatment and irinotecan monotherapy were compared in this systematic analysis. Gastric cancer ranks third in cancer-related mortality both worldwide and in China [1, 2]. There are over one million new cases of gastric cancer and 800,000 gastric cancer related deaths worldwide [1]. Even after radical surgery and adjuvant chemotherapy, the risk of local recurrence and distant metastasis remains high. For patients with advanced gastric cancer (AGC), palliative chemotherapy could delay disease progression and increase the quality of life. Chemotherapy based on fluorouracil or platinum is the standard first-line therapy [3, 4]. Even after receiving first-line chemotherapy, the gastric cancer continues to progress and metastasize
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