title: S-1-based combination therapy vs S-1 monotherapy in advanced gastric cancer: a meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy and safety of combination therapy based on S-1, a novel oral fluoropyrimidine, vs S-1 monotherapy in advanced gastric cancer (AGC).
  
  
  METHODS
  We searched PubMed, EMBASE and the Cochrane Library for eligible studies published before March 2013. Our analysis identified four randomized controlled trials involving 790 participants with AGC. The outcome measures were overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and grade 3-4 adverse events.
  
  
  RESULTS
  Meta-analysis showed that S-1-based combination therapy significantly improved OS (HR = 0.77, 95%CI: 0.66-0.91, P = 0.002), PFS (HR = 0.58, 95%CI: 0.46-0.72, P = 0.000) and ORR (OR = 2.23, 95%CI: 1.54-3.21, P = 0.000). Sensitivity analysis further confirmed this association. Lower incidence of grade 3-4 leucopenia (OR = 4.06, 95%CI: 2.11-7.81), neutropenia (OR = 3.94, 95%CI: 2.1-7.81) and diarrhea (OR = 2.41, 95%CI: 1.31-4.44) was observed in patients with S-1 monotherapy.
  
  
  CONCLUSIONS
  S-1-based combination therapy is superior to S-1 monotherapy in terms of OS, PFS and ORR. S-1 monotherapy is associated with less toxicity.
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Guo-Fang
authors.initials: GF
authors.lastname: Liu
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Tang
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Su
authors.initials: S
authors.lastname: Wang
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Ya-Xiang
authors.initials: YX
authors.lastname: Xu
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Long
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Nian-Lan
authors.initials: NL
authors.lastname: Zhou
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Zhang
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Guo-Fang Liu, Su Wang, Ai-Hua Long, Nian-Lan Zhou, Li-Li Zhang, Xiao-Xing Xiang, Department of Gastroenterology and Hepatology, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou 225000, Jiangsu Province, China.
authors.forename: Xiao-Xing
authors.initials: XX
authors.lastname: Xiang
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D004338:Drug Combinations; D006801:Humans; D016017:Odds Ratio; D010094:Oxonic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005641:Tegafur / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid
keywords: Advanced gastric cancer; Chemotherapy; Meta-analysis; Overall survival; S-1