Chemotherapy for advanced gastric cancer.

Détails

ID Serval
serval:BIB_408945228D7E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Chemotherapy for advanced gastric cancer.
Périodique
Cochrane Database of Systematic Reviews
Auteur(s)
Wagner A.D., Unverzagt S., Grothe W., Kleber G., Grothey A., Haerting J., Fleig W.E.
ISSN
1469-493X (Electronic)
ISSN-L
1361-6137
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
3
Numéro
3
Pages
CD004064
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Review Publication Status: epublish
Résumé
BACKGROUND: Gastric cancer currently ranks second in global cancer mortality. Most patients are either diagnosed at an advanced stage, or develop a relapse after surgery with curative intent. Apart from supportive care and palliative radiation to localized (e.g. bone) metastasis, systemic chemotherapy is the only treatment option available in this situation.
OBJECTIVES: To assess the efficacy of chemotherapy versus best supportive care, combination versus single agent chemotherapy and different combination chemotherapy regimens in advanced gastric cancer.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE up to March 2009, reference lists of studies, and contacted pharmaceutical companies and national and international experts.
SELECTION CRITERIA: Randomised controlled trials on systemic intravenous chemotherapy versus best supportive care, combination versus single agent chemotherapy and different combination chemotherapies in advanced gastric cancer.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data. A third investigator was consulted in case of disagreements. We contacted study authors to obtain missing information.
MAIN RESULTS: Thirty five trials, with a total of 5726 patients, have been included in the meta-analysis of overall survival. The comparison of chemotherapy versus best supportive care consistently demonstrated a significant benefit in overall survival in favour of the group receiving chemotherapy (hazard ratios (HR) 0.37; 95% confidence intervals (CI) 0.24 to 0.55, 184 participants). The comparison of combination versus single-agent chemotherapy provides evidence for a survival benefit in favour of combination chemotherapy (HR 0.82; 95% CI 0.74 to 0.90, 1914 participants). The price of this benefit is increased toxicity as a result of combination chemotherapy. When comparing 5-FU/cisplatin-containing combination therapy regimens with versus without anthracyclines (HR 0.77; 95% CI 0.62 to 0.95, 501 participants) and 5-FU/anthracycline-containing combinations with versus without cisplatin (HR 0.82; 95% CI 0.73 to 0.92, 1147 participants) there was a significant survival benefit for regimens including 5-FU, anthracyclines and cisplatin. Both the comparison of irinotecan versus non-irinotecan (HR 0.86; 95% CI 0.73 to 1.02, 639 participants) and docetaxel versus non-docetaxel containing regimens (HR 0.93; 95% CI 0.75 to 1.15, 805 participants) show non-significant overall survival benefits in favour of the irinotecan and docetaxel-containing regimens.
AUTHORS' CONCLUSIONS: Chemotherapy significantly improves survival in comparison to best supportive care. In addition, combination chemotherapy improves survival compared to single-agent 5-FU. All patients should be tested for their HER-2 status and trastuzumab should be added to a standard fluoropyrimidine/cisplatin regimen in patients with HER-2 positive tumours. Two and three-drug regimens including 5-FU, cisplatin, with or without an anthracycline, as well as irinotecan or docetaxel-containing regimens are reasonable treatment options for HER-2 negative patients.
Mots-clé
Anthracyclines/administration & dosage, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Camptothecin/administration & dosage, Camptothecin/analogs & derivatives, Cisplatin/administration & dosage, Fluorouracil/administration & dosage, Humans, Randomized Controlled Trials as Topic, Stomach Neoplasms/drug therapy, Stomach Neoplasms/mortality, Taxoids/administration & dosage
Pubmed
Web of science
Open Access
Oui
Création de la notice
06/04/2010 16:48
Dernière modification de la notice
08/05/2019 17:37
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