Third-line chemotherapy in advanced gastric cancer: A systematic review and meta-analysis.
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ABSTRACT: Backgound
Little information regarding to the survival advantage of third-line chemotherapy in advanced gastric cancer patients is available. The current study is designed to systematically review and perform meta-analysis on the effect of third-line chemotherapy on progressive or recurrent gastric cancer treatment.Methods
After thorough searching of online databases, total 20 articles were included into qualitative systematic review and 6 of them were used to conduct qualitative meta-analysis.Results
It was found that the third-line chemotherapy was superior to placebo or best supportive care in terms of prolonging median oval survival (OS) length and progress free survival (PFS) length (Hedges's g for OS?=?-0.315?±?0.077, P?ConclusionThe third-line chemotherapy is superior to the best supportive care in advanced gastric cancer patients who had been pretreated with first-line and second-line chemotherapy.
SUBMITTER: Zheng Y
PROVIDER: S-EPMC5478304 | biostudies-literature | 2017 Jun
REPOSITORIES: biostudies-literature
Publications
Third-line chemotherapy in advanced gastric cancer: A systematic review and meta-analysis.
Zheng Yu Y Zhu Xu-Qing XQ Ren Xiao-Gang XG
Medicine 20170601 24
<h4>Backgound</h4>Little information regarding to the survival advantage of third-line chemotherapy in advanced gastric cancer patients is available. The current study is designed to systematically review and perform meta-analysis on the effect of third-line chemotherapy on progressive or recurrent gastric cancer treatment.<h4>Methods</h4>After thorough searching of online databases, total 20 articles were included into qualitative systematic review and 6 of them were used to conduct qualitative ...[more]
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Project description:BackgroundMany options for third-line treatment of advanced gastric cancer (GC) or gastroesophageal junction carcinoma (GEJC) have been developed. Therapies including immunotherapy (nivolumab), chemotherapy (irinotecan, FTD/TPI), targeted therapy (apatinib), and antibody drug conjugates (ADC) have shown to increase the survival rates in patients, but few studies have compared the relative efficacy of these treatments. Here, we compared the efficacies of these regimens using network meta-analysis (NMA) to provide guides in selecting the best regimen and formulating a precise individualized treatment plan.MethodsThe published RCTs of phase II/III in PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched. The median overall survival (mOS) was the primary outcome of NMA, and the other outcomes were median progression-free survival (mPFS), disease control rate (DCR) (proportion of patients with confirmed CR, PR, or stable disease (SD)) and incidence of grade 3 or above adverse events (≥3AEs).ResultsFive phase II/III RCTs involving 1674 patients and 7 treatment regimens were analyzed. It showed that Trastuzumab Deruxtecan (DS-8201) prolonged the OS of patients significantly comparing with chemotherapy (HR: 0.59; 95% CI: 0.39-0.89) for the overall population. DS-8201 (HR: 0.27; 95% CI: 0.17-0.42) and chemotherapy (HR: 0.57; 95% CI: 0.47-0.7) improved the PFS significantly over nivolumab. Apatinib (RR: 3.04; 95% CI: 1.65-5.95) and DS-8201 (RR: 2.67; 95% CI: 1.51-4.83) were more effective than nivolumab in improving DCR. DS-8201 achieved greater OS benefits compared to chemotherapy (HR: 0.59; 95% CI: 0.39-0.88) for patients who were HER2-positive. We ranked the Bayesian surface under the cumulative ranking curve according to OS benefit, and showed that ADC ranked first for the general patient population and for patients with a HER2-positive diagnosis, intestinal histopathology, previous gastrectomy history, gastric origination cancer, ages over 65 and ECOG PS=0/1, followed by nivolumab and apatinib. For patients with GEJC, nivolumab ranked first.ConclusionsNivolumab, apatinib, chemotherapy, and ADC all improved the OS of GC/GEJC patients significantly. ADC may be the best option for the overall population of GC, as well as for patients with HER2-overexpression, intestinal histopathology, previous gastrectomy history, gastric origination cancer, ages over 65 and ECOG PS=0/1, followed by nivolumab and apatinib. Nivolumab may be the first treatment option for GEJC patients.Systematic review registrationhttps://www.crd.york.ac.uk/prospero, identifier CRD42022364714.
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