Abstract
BackgroundAlthough both oral fluoropyrimidines were reported effective and safe, doubts exist about whether S-1 or capecitabine is more advantageous in advanced gastric carcinoma (AGC). Herein, we performed a meta-analysis to comprehensively compare the efficacy and safety of S-1-based chemotherapy versus capecitabine-based chemotherapy as first-line treatment for AGC. MethodsPubMed/Medline, EmBase, Cochrane library, and China National Knowledge Infrastructure databases were searched for articles comparing S-1-based chemotherapy to capecitabine-based chemotherapy for AGC. Primary outcomes were overall response rate (ORR), time to progression (TTP), overall survival (OS), progression-free probability, and survival probability. Secondary outcomes were toxicities. Fixed-effects model were used and all the results were confirmed by random-effects model. ResultsFive randomized controlled trials and five cohort studies with 821 patients were included. We found equivalent ORR (38.3% vs. 39.1%, odds ratio [OR] 0.92, 95% confidence interval [CI] 0.69-1.24, P = 0.59), TTP (harzad ratio [HR] 0.98, 95% CI 0.82-1.16, P = 0.79), OS (HR 0.99, 95% CI 0.87-1.13, P = 0.91), progression-free probability (3-month OR 1.02, 95% CI 0.62-1.68, P = 0.94; 6-month OR 1.34, 95% CI 0.88-2.04, P = 0.18) and survival probability (0.5-year OR 0.90, 95% CI 0.61-1.31, P =0.57; 1-year OR 0.97, 95% CI 0.70- 1.33, P = 0.84; 2-year OR 1.15, 95% CI 0.61-2.17, P = 0.66). Equivalent grade 3 to 4 hematological and non-hematological toxicities were found except hand-foot syndrome was less prominent in S-1-based chemotherapy (0.3% vs. 5.9%, OR 0.19, 95% CI 0.06-0.56, P = 0.003). There’re no significant heterogeneity and publication bias. Cumulative analysis found stable time-dependent trend. Consistent results stratified by study design, age, regimen, cycle, country were observed.ConclusionS-1-based chemotherapy was associated with non-inferior antitumor efficacy and better safety profile, compared with capecitabine-based therapy. We recommended S-1 and capecitabine can be used interchangeably for AGC, at least in Asia.
Highlights
Gastric carcinoma ranks second among the most common causes of cancer deaths worldwide, with especial high prevalence in Asia [1,2,3]
A globally accepted standard regimen has not been established, among which fluoropyrimidines comprise the backbone of chemotherapy for advanced gastric carcinoma (AGC) and the optimization was established by extensive research [7,8]
There were no significant differences in the baselines between S-1-based arm and capecitabine-based arm in these studies, as reported
Summary
Gastric carcinoma ranks second among the most common causes of cancer deaths worldwide, with especial high prevalence in Asia [1,2,3]. A large number of gastric cancer patients present with advanced disease (unresectable, recurrent or metastatic disease) precluding surgery and chemotherapy becomes the most effective treatment [4,5,6]. A globally accepted standard regimen has not been established, among which fluoropyrimidines comprise the backbone of chemotherapy for advanced gastric carcinoma (AGC) and the optimization was established by extensive research [7,8]. Capecitabine-based combinations have become the standard treatment for AGC globally. Both oral fluoropyrimidines were reported effective and safe, doubts exist about whether S-1 or capecitabine is more advantageous in advanced gastric carcinoma (AGC). We performed a meta-analysis to comprehensively compare the efficacy and safety of S-1-based chemotherapy versus capecitabine-based chemotherapy as first-line treatment for AGC. We recommended S-1 and capecitabine can be used interchangeably for AGC, at least in Asia
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