Abstract
There is a debate as to whether anti-angiogenic molecular agents can produce survival benefits in patients with previously treated advanced gastric cancer (GC) or gastroesophageal junction cancer (GEJC). We performed this meta-analysis of randomized trials to evaluate the survival outcomes of an anti-angiogenic agent versus placebo in the salvage treatment of advanced GC or GEJC. Electronic databases were searched for eligible studies. From the four studies, 910 patients with previously treated advanced GC or GEJC were included in the meta-analysis. Compared with placebo, anti-angiogenic targeted agents significantly improved progression-free survival (hazard ratio = 0.37 [95% confidence interval, 0.26–0.53], P < 0.00001). In terms of overall survival, anti-angiogenic agents induced 36% reduction in the risk for death (hazard ratio = 0.64 [95% confidence interval, 0.48–0.86], P = 0.002). In conclusion, this meta-analysis demonstrates that anti-angiogenic agents can prolong survival in patients with previously treated advanced GC or GEJC. This finding suggests that anti-angiogenic therapy can be a considerable option in patients who are not candidates for further chemotherapy.
Highlights
Gastric cancer (GC) is one of the most common cancers worldwide, in terms of incidence as well as mortality [1, 2]
The meta-analysis of four randomized studies indicates that anti-angiogenic therapy alone can prolong survival over that with placebo in patients with previously treated advanced gastric cancer (GC) or gastroesophageal junction cancer (GEJC)
The AVAGAST study evaluating the efficacy of bevacizumab, a monoclonal antibody to Vascular endothelial growth factor (VEGF), in combination with chemotherapy in patients with chemotherapy-naïve advanced GC failed to show statistically significant improvement of progression-free survival (PFS) and overall survival (OS) [16]
Summary
Gastric cancer (GC) is one of the most common cancers worldwide, in terms of incidence as well as mortality [1, 2]. Its incidence in individuals younger than 50 years has increased recently, GC develops more frequently among patients in their seventh or eighth decades [2]. Radical surgery with or without perioperative or adjuvant chemotherapy is the potential curative treatment for patients with localized GC, but a considerable number of patients present with advanced disease at the time of diagnosis. More than half patients treated by complete resection eventually develop recurrent diseases during the course of their disease [3, 4]. Combination of fluoropyrimidine and platinum has been established worldwide as the first-line therapy for advanced GC [5]. Most patients become resistant to the first-line chemotherapy. The development of more effective salvage treatment is still warranted
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