Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis.
BACKGROUND
Many patients with refractory or relapsed gastric cancer after first-line chemotherapy have received salvage chemotherapy in routine clinical practice. However, there was no evidence to support this treatment until recent phase III trials demonstrated substantial prolongation of overall survival. Therefore, we conducted a meta-analysis of these trials and investigated whether second-line chemotherapy was more effective than best supportive care.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1, 2013), MEDLINE (1950 to March week 4, 2013) and EMBASE (1980-2013, week 13). In addition, we searched all abstracts and virtual meeting presentations from the American Society of Clinical Oncology (ASCO) conferences held between 2004 and 2013.


RESULTS
The search process yielded 578 studies, two of which were randomized phase III trials that compared chemotherapy with supportive care. From the abstracts and virtual meeting presentations of ASCO held between 2004 and 2013, 127 abstracts were identified that evaluated second-line chemotherapy; only one relevant abstract was included in the meta-analysis. A total of 410 patients were eligible for analysis, of whom 150 received docetaxel chemotherapy, and 81 received irinotecan chemotherapy. A significant reduction in the risk of death [HR = 0.64, 95% confidence interval (CI) 0.52-0.79, P < 0.0001] was observed with salvage chemotherapy. When the analysis was restricted to irinotecan or docetaxel, there was still significant reduction in the risk of death with each chemotherapeutic agent. The HR was 0.55 (95% CI 0.40-0.77, P = 0.0004) for irinotecan and 0.71 (95% CI 0.56-0.90, P = 0.004) for docetaxel.


CONCLUSIONS
This meta-analysis demonstrated evidence to support second-line chemotherapy in advanced gastric cancer.
Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang.
H S
HS
Kim
H J
HJ
Kim
S Y
SY
Kim
T Y
TY
Kim
K W
KW
Lee
S K
SK
Baek
T Y
TY
Kim
M H
MH
Ryu
B H
BH
Nam
D Y
DY
Zang
D000970:Antineoplastic Agents / Q000008:administration & dosage; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017326:Clinical Trials, Phase III as Topic; D000077143:Docetaxel; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009367:Neoplasm Staging; D016032:Randomized Controlled Trials as Topic; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D043823:Taxoids / Q000008:administration & dosage*
D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin
advanced gastric cancer; best supportive care; meta-analysis; second-line chemotherapy