title: Effectiveness and safety of oxaliplatin compared to cisplatin for advanced, unresectable gastric cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  Cisplatin has been largely used in the treatment of advanced, unresectable gastric cancer, mainly in combinations with fluoropyrimidines and anthracyclines. Oxaliplatin has been shown to be at least as effective as cisplatin for this disease, but with less toxicity and a better tolerability profile, especially for older patients. We performed a systematic review of the literature to address and quantify differences in the efficacy and the safety between oxaliplatin and cisplatin for the treatment of this disease.
  
  
  METHODS
  The literature was searched for randomized controlled trials (RCTs) comparing oxaliplatin to cisplatin. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to analyze dichotomous variables. Hazard ratios (HRs) for progression and death were combined with an inverse variance method based on logarithmic conversion. A fixed effect model and Mantel-Haenszel's (M-H) method were used. Heterogeneity was tested with the Q test and the I (2) value. Sensitivity analyses were performed.
  
  
  RESULTS
  Three RCTs were identified, involving a total of 1294 patients. Oxaliplatin significantly improved progression-free survival (HR = 0.88, p = 0.02) and overall survival (HR = 0.88, p = 0.04). Moreover, it was associated with less neutropenia (OR = 0.53, p < 0.01) and fewer thromboembolic events (OR = 0.42, p < 0.01), but it was also associated with increased neurotoxicity (OR = 6.91, p < 0.01).
  
  
  CONCLUSIONS
  Our results support the existence of a small but significant survival benefit of oxaliplatin over cisplatin. Oxaliplatin is associated with less toxicity and better tolerability, especially in older patients and when used in two-drug, bi-weekly regimens.
authors.affiliation: Department of Medicine, S. Giuseppe Hospital, Empoli, Florence, Italy. iago2003@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Montagnani
authors.forename: Gina
authors.initials: G
authors.lastname: Turrisi
authors.forename: Claudio
authors.initials: C
authors.lastname: Marinozzi
authors.forename: Camillo
authors.initials: C
authors.lastname: Aliberti
authors.forename: Giammaria
authors.initials: G
authors.lastname: Fiorentini
mesh_terms: D002945:Cisplatin / Q000009:adverse effects* / Q000627:therapeutic use*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000188:drug therapy*; D006801:Humans; D009944:Organoplatinum Compounds / Q000009:adverse effects* / Q000627:therapeutic use*; D000077150:Oxaliplatin; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002945:Cisplatin