Chemotherapy for advanced gastric cancer.

Details

Serval ID
serval:BIB_858743322F30
Type
Article: article from journal or magazin.
Collection
Publications
Title
Chemotherapy for advanced gastric cancer.
Journal
Cochrane Database of Systematic Reviews
Author(s)
Wagner A.D., Grothe W., Behl S., Kleber G., Grothey A., Haerting J., Fleig W.E.
ISSN
1469-493X (Electronic)
ISSN-L
1361-6137
Publication state
Published
Issued date
2005
Volume
11
Number
2
Pages
CD004064
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Review
Publication Status: epublish
Abstract
BACKGROUND: Gastric cancer currently ranks second in global cancer mortality. Most patients are either diagnosed at an advanced stage, or develop a relapse after apparently curative operation. Apart from supportive measures, systemic chemotherapy is the only treatment option available in this situation.
OBJECTIVES: To assess the effect 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 (The Cochrane Library Issue 1, 2004), MEDLINE and EMBASE up to February 2004 and reference lists of articles. We also contacted pharmaceutical companies as well as 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: Chemotherapy versus best supportive care consistently demonstrated a significant benefit in terms of overall survival in favour of the group receiving chemotherapy (Hazard Ratios (HR) 0.39; 95% confidence intervals (CI) 0.28 to 0.52). Combination versus single-agent chemotherapy provides evidence for a survival benefit in favour of combination chemotherapy (HR 0.85; 95% CI 0.76 to 0.96). Numbers included in these comparisons were 184 and 1338 participants respectively. This benefit is achieved at the price of increased toxicity in the combination chemotherapy arms. When comparing 5-FU/cisplatin-containing combination therapy regimens with anthracyclines versus those without anthracyclines (HR 0.77; 95% CI 0.62 to 0.95 based on 501 participants) and 5-FU/anthracycline-containing combinations with cisplatin versus those without cisplatin (HR 0.83; 95% CI 0.76 to 0.91 based on 1147 participants), there was a significant survival benefit for regimens including 5-FU, anthracyclines and cisplatin.
AUTHORS' CONCLUSIONS: Chemotherapy significantly improves survival in comparison to best supportive care. In addition, combination chemotherapy improves survival compared to single-agent 5-FU, but the effect size is much smaller. Among the combination chemotherapy regimens studied, best survival results are achieved with regimens containing 5-FU, anthracyclines and cisplatin. In this category, ECF (epirubicin, cisplatin and continuous infusion 5-FU) is tolerated best.
Keywords
Anthracyclines/administration & dosage, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Cisplatin/administration & dosage, Fluorouracil/administration & dosage, Humans, Randomized Controlled Trials as Topic, Stomach Neoplasms/drug therapy
Pubmed
Open Access
Yes
Create date
16/02/2016 18:34
Last modification date
20/08/2019 15:44
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