title: The efficacy and toxicity of paclitaxel plus S-1 compared with paclitaxel plus 5-FU for advanced gastric cancer: a PRISMA systematic review and meta-analysis of randomized controlled trials.
abstract: The standard treatment for patients with advanced gastric cancer (AGC) is still a matter of debate. The chemotherapy regimen of paclitaxel (PTX) combined with S-1 has been used to treat AGC or metastatic gastric cancer.We conducted a meta-analysis to compare oral S-1 and infusional 5-fluorouracil (5-FU) to determine which agent was more efficacious and less toxic in combination with PTX. A systematic review with a meta-analysis was performed. PubMed, EmBase, the Cochrane Central Register of Controlled Trials, and the China National Knowledge Infrastructure databases were searched to select randomized controlled trials (RCTs) comparing PTX plus S-1 and PTX plus 5-FU in patients with AGC.Three RCTs were eligible and 352 patients were analyzed. PTX plus S-1 increased the disease control rate (risk ratio [RR] = 1.14, 95% confidence interval [CI] = 1.00-1.30, P = 0.04) and reduced the progressive disease rate (RR = 0.62, 95% CI] = 0.39-0.98, P = 0.04) compared with PTX plus 5-FU. There was a significant decrease in nausea (RR = 0.60, 95% CI = 0.43-0.82, P = 0.001) and vomiting (RR = 0.55, 95% CI = 0.33-0.91, P = 0.02) in patients treated with PTX plus S-1.PTX plus S-1 was associated with almost equivalent safety and a lower progressive disease rate compared with PTX plus 5-FU. PTX plus S-1 is a good alternative strategy for patients who cannot tolerate a continuous intravenous infusion.
authors.affiliation: From the Department of Surgical Oncology and General Surgery, First Hospital of China Medical University (HL, XC, JS, PG, YS, XL, HX, ZW) and Department of Pathophysiology, School of Basic Medical of China Medical University (NZ), Shenyang, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Liu
authors.forename: Xiaowan
authors.initials: X
authors.lastname: Chen
authors.forename: Jingxu
authors.initials: J
authors.lastname: Sun
authors.forename: Peng
authors.initials: P
authors.lastname: Gao
authors.forename: Yongxi
authors.initials: Y
authors.lastname: Song
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Lu
authors.forename: Huimian
authors.initials: H
authors.lastname: Xu
authors.forename: Zhenning
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018450:Disease Progression; D004338:Drug Combinations; D005472:Fluorouracil / Q000008:administration & dosage; D009367:Neoplasm Staging; D010094:Oxonic Acid / Q000008:administration & dosage; D012307:Risk Factors; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality; D005641:Tegafur / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D005472:Fluorouracil