title: Chemotherapy with or without irinotecan in patients with advanced or recurrent gastric cancer: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Studies have shown that irinotecan can improve survival in patients with advanced or recurrent gastric cancer, but the overall benefit of irinotecan in the treatment of advanced or recurrent gastric cancer remains controversial. The aim of this study was to evaluate the benefits and risks of irinotecan for survival in patients with advanced or recurrent gastric cancer. Method We searched PubMed, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major conferences for relevant clinical trials. We included randomized controlled trials that reported on the efficacy and safety of irinotecan in patients with advanced or recurrent gastric cancer. Outcomes were analyzed by survival rate, objective response rate (ORR), and toxicity. Furthermore, the analysis was further stratified by factors that could affect the treatment effects.
  
  
  RESULTS
  Eight trials recruiting 1 546 patients with advanced or recurrent gastric cancer were included in the analysis. Overall, irinotecan therapy was associated with a 6% improvement in survival rate, but this difference was not statistically significant (odds ratio (OR) 0.94; 95% confidence interval (95% CI) 0.70-1.27; P = 0.69). However, irinotecan therapy had more frequent ORR than irinotecan-free arm (OR 1.70; 95% CI 1.34-2.17; P < 0.001). Furthermore, irinotecan therapy was associated with a clinically and statistically significant increase in the risk for declined hemoglobin, hyponatremia, and diarrhea, but it also protected against thrombocytopenia risk when compared with irinotecan-free therapy.
  
  
  CONCLUSIONS
  There is no evidence to support the use of irinotecan therapy in patients with advanced or recurrent gastric cancer; however, given the significant advantage in ORR irinotecan therapy using combination regimens may be considered for further evaluation in subsets of patients who may benefit from this treatment.
authors.affiliation: Department of Gastroenterology, Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zeng
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wei
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China.
authors.forename: Liyang
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of Chemotherapy, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, China. Email: yaowenxiu_2011@126.com.
authors.forename: Wenxiu
authors.initials: W
authors.lastname: Yao
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D000077146:Irinotecan; D002166:Camptothecin